{"id":"439fa39e39f4","type":"article","url":"https://hartvaat.nl/2025/10/14/heparine-bij-eerste-medisch-contact-versus-voor-primaire-pci-bij-stemi/","title":"Heparine bij eerste medisch contact versus vóór primaire PCI bij STEMI","title_en":"Heparin administration at first medical contact vs immediately before primary percutaneous coronary intervention: the HELP-PCI trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["anticoagulantia"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf481","source_url":"https://doi.org/10.1093/eurheartj/ehaf481","authors":["Jing Chen","Changwu Xu","Liqiang Qiu","Bin Li","Wei Yao","Hui Wu","Longcai Hu","Guang Xu","Dongmei Zhu","Zhengzai Li","Xiaolin Wu","Chuang Xiao","Bo Liu","Xiuzhen Shen","Zhaowu Deng","Chaogui Zhuo","Huajun Su","Keping Yang","Youen Zhang","Meichun Zhang","Chang Li","Xuexiang Lv","Lifeng Hong","Fan Guo","Xingan Wu","Hao Xu","Mingjian Li","Liqun He","Wenjun Wu","Yuhua Lei","Dongsheng Li","Huoping Li","Shaoze Chen","Hong Bao","Xuguang Xiong","Bo Liu","Guokang Yang","Jinke Chen","Xiao Lan","Qibin Zheng","Guanglong Yang","Mingxi Zhang","Jian Yang","Hong Jiang"],"significance":6,"published":"2025-10-14","source_date":"2025-10-14","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/esc-richtlijn-acs-2023/"],"congress":"","summary_en":"This study evaluated whether early heparin administration at first medical contact improves STEMI outcomes compared with administration immediately before PCI, informing the timing of antithrombotic therapy in acute MI care pathways.","created":"2026-07-03T10:31:55Z","updated":"2026-07-03T13:30:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht of vroege heparine-toediening bij eerste medisch contact de uitkomsten bij STEMI verbetert. De timing van antistolling kan de reperfusiekwaliteit beïnvloeden.","abstract_original":"BACKGROUND AND AIMS: The beneficial effect of pre-treatment with unfractionated heparin (UFH) at first medical contact (FMC) before primary percutaneous coronary intervention (PPCI) in all-comers with ST-elevation myocardial infarction (STEMI) remains uncertain. METHODS: HELP-PCI was an investigator-initiated, randomized controlled trial conducted at 36 clinical centres in China. Patients with STEMI presenting ≤12 h after symptom onset undergoing PPCI were randomly assigned (1:1) to intravenous administration with UFH (100 U/kg) at FMC or in the Cath Lab through a catheter sheath. The primary endpoint was Thrombolysis in Myocardial Infarction flow grade (TFG)-3 of infarct-related artery (IRA) at diagnostic angiography before PPCI. The secondary outcome was complete epicardial and myocardial reperfusion after PPCI and major adverse cardiac and cerebrovascular events (MACCE; defined as the composite of all-cause death, cardiac death, heart failure hospitalizations, re-infarction, stent thrombosis, unplanned revascularization, and stroke) at 12 months. Safety outcome was 30-day Bleeding Academic Research Consortium (BARC) type ≥2 bleeding. RESULTS: A total of 999 patients with STEMI undergoing PPCI were randomly assigned to receive either UFH administration at FMC (n = 505) or in the Cath Lab (n = 494). Pre-treated population at FMC showed a higher frequency of TFG-3 of IRA compared with the Cath Lab group (23.6% vs 17.6%; odds ratio, 1.44; 95% confidence interval, 1.06-1.97; P = .02). There were no significant differences in secondary endpoints or in the safety endpoint, including 12-month MACCE, complete epicardial and myocardial reperfusion, and major bleeding. CONCLUSIONS: Pre-treatment with loading-dose UFH at FMC was associated with an improvement of spontaneous reperfusion of IRA without increasing the risk of major bleeding."}