Pre-treatment with loading-dose heparin upon first medical contact (FMC) was associated with improved spontaneous reperfusion of infarct‐related artery (IRA) without increasing the risk of major bleeding, reports new data from the HELP-PCI trial. Treatment with the loading dose of unfractionated heparin (UFH) at FMC was also found to improve 30-day major adverse cardiac and cerebrovascular events (MACCE) and readmissions for heart failure. Findings from the HELP-PCI trial were presented by Jing Chen, PhD, of the Renmin Hospital of Wuhan University,, China, at Transcatheter Cardiovascular Technologies (TCT) 2024 meeting in Washington, DC on Monday. Speaking at TCT 2024, Chen noted that achieving early restoration of blood flow in infarct-related artery (IRA) is one of the main goals of primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction (STEMI) patients. As such, unfractionated heparin (UFH) is frequently administered before primary PCI procedure in patients with STEMI. “Pretreatment with [a] loading-dose UFH at FMC could be considered to reduce the inherent delay from FMC to Cathlab in the current regional networks, thereby attenuating myocardial injury and improving clinical prognosis in patients with STEMI,” he said. Study setup Despite several observation studies reporting that pre-treatment with UFH may improve early restoration of myocardial blood flow, the researcher noted that evidence from RCTs has so far been lacking on whether early upstream administration of UFH improves the short-term or long-term prognosis in STEMI patients undergoing primary PCI. The HELP-PCI trial evaluated the effect of administration of UFH at first medical contact (FMC) versus in the catheterization laboratory (Cathlab). A total of 999 STEMI patients (82% male, 59-60 years old) were randomized to receive UFH either in the Cathlab (n=494) or upon FMC (n=505). There were no differences in baseline characteristics or demographics between to the two randomization groups, nor were there any significant differences in time intervals for primary PCI between the 2 treatment groups, said Chen — noting that the only differences between groups were related to the timing of heparin. For example, time from symptoms to heparin was 3.1 hrs (2.05-4.90) in the Cathlab group versus 2.85 (1.85-4.95) for FMC (p = 0.002), while time from randomization to heparin was just 5 minutes, on average, for the FMC group, while it was 31 minutes for the Cathlab groups (p = < 0.001). The primary endpoint was TIMI flow grade 3 of the infarct related artery at diagnostic angiography before PPCI procedure. The safety endpoint was major bleeding (BARC ≥ 2) events at 30 days. Key findings Data from the HELP-PCI trial found that pre-treatment with UFH at FMC improved spontaneous reperfusion of IRA, said Chen, noting that at diagnostic angiography before PPCI procedure 23.6% of FMC patients had TIMI flow grade 3 at IRA while 17.6% of Cathlab patients achieved Grade 3 (relative risk [RR], 1.34; 95% confidence interval [CI] 1.04-1.71; p=0.02). Furthermore, there were no significant differences in secondary composite endpoints, said Chen. “Pre-treatment with loading-dose UFH at FMC was associated with improved spontaneous reperfusion of IRA without increasing the risk of major bleeding,” he noted, adding that FMC heparin improved 30-day MACCE “and most importantly reduces readmission for heart failure.” Image Caption: Jing Chen, PhD, speaks during a news conference Monday at the Transcatheter Cardiovascular Therapeutics (TCT) conference in Washington, DC. Image Credit: Bailey G. Salimes/CRTonline.org