The effect of heparin prescription before primary PCI on long-term and short-term clinical and para clinical results and the mortality of patients with acute coronary syndrome


  • Bijan Zamani Department of Medicine, Ardabil University of Medical Science, Ardabil, Iran
  • Asghar Abdollahi Department of Medicine, Ardabil University of Medical Science, Ardabil, Iran
  • Afrooz Mardi Department of Medicine, Ardabil University of Medical Science, Ardabil, Iran



Clinical outcome, Heparin, Primary PCI, ST elevated Myocardial infarction


Background: Primary PCI (PPCI) is the main reperfusion treatment for ST-segment elevation myocardial infarction (STEMI). Anticoagulation therapy should be administered in patients undergoing PCI in order to limit the ischemic complications. In this study, we evaluated the effect of bolus unfractionated heparin (UFH) before PPCI on clinical outcome of patients with STEMI.

Methods: In this randomized clinical trial, 196 patients (72.4% male with mean age of 63.02±13.37 years) with STEMI undergoing PPCI were randomly assigned to receive bolus UFH 60-90 U/kg in emergency room (case group) or during PCI (control group). Clinical outcomes, 30 day mortality, hematoma, left ventricle function improvement during follow-up were compared between groups.

Results: In both groups there was good flow in the involved coronary artery after PCI. Case group compared to control group had significantly more cases with improved LVEF (28.1% vs. 9.7%, p=0.005). Also, case group compared to control group had more hematoma (3.1% vs. 0%, p=0.24) and higher mortality rate (6% vs. 4.2%, p=0.56) which had no significant difference between groups.

Conclusions: PPCI in patients with STEMI accompanies with acceptable coronary flow irrespective of receiving bolus heparin. Receiving bolus heparin in these patients may have improved left ventricle function by increasing the rate of reflow. However, using bolus heparin did not accompany with increased rate of bleeding and had no effect on 30 day mortality rate.


Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart Disease and Stroke Statistics- 2015 update: a report from the American Heart Association. Circulation. 2015;131:e29-e322.

Longo DKD, Jameson L, Fausi A, Hauser S, Loscalzo J. Principles of Harrison's Internal Medicine. 18th Edition; 2012:495.

Sotos-Prieto M, Baylin A, Campos H, Qi L, Mattei J. Lifestyle Cardiovascular Risk Score, Genetic Risk Score, and Myocardial Infarction in Hispanic/Latino Adults Living in Costa Rica. J Am Heart Assoc. 2016 Dec 20;5(12):pii:e004067.

Danese E, Montagnana M. An historical approach to the diagnostic biomarkers of acute coronary syndrome. Ann Transl Med. 2016 May;4(10):194.

Beig JR, Tramboo NA, Kumar K, Yaqoob I, Hafeez I, Rather FA, et al. Components and determinants of therapeutic delay in patients with acute ST-elevation myocardial infarction: A tertiary care hospital-based study. J Saudi Heart Assoc. 2017 Jan;29(1):7-14.

Windecker S, Hernández-Antolín RA, Stefanini GG, Wijns W, Zamorano JL. Management of ST-elevation myocardial infarction according to European and American guidelines. EuroIntervention. 2014 Aug;10 Suppl T:T23-31.

American College of Emergency Physicians; Society for Cardiovascular Angiography and Interventions, O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, et al. ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Jan 29;61(4):e78-140.

Guillermin A, Yan DJ, Perrier A, Marti C. Safety and efficacy of tenecteplase versus alteplase in acute coronary syndrome: a systematic review and meta-analysis of randomized trials. Arch Med Sci. 2016 Dec 1;12(6):1181-7.

Briguori C, Visconti G, Focaccio A, Donahue M, Golia B, Selvetella L, et al. Novel approaches for preventing or limiting events (Naples) III trial: randomized comparison of bivalirudin versus unfractionated heparin in patients at increased risk of bleeding undergoing transfemoral elective coronary stenting. JACC Cardiovasc Interv. 2015 Mar;8(3):414-23.

Miyachi H, Takagi A, Miyauchi K, Yamasaki M, Tanaka H, Yoshikawa M, et al. Current characteristics and management of ST elevation and non-ST elevation myocardial infarction in the Tokyo metropolitan area: from the Tokyo CCU network registered cohort. Heart Vessels. 2016 Nov;31(11):1740-51.

Cho JS, Her SH, Baek JY, Park MW, Kim HD, Jeong MH, et al. Clinical benefit of low molecular weight heparin for ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with glycoprotein IIb/IIIa inhibitor. J Korean Med Sci. 2010 Nov;25(11):1601-8.

Ottervanger JP, van't Hof AW, Reiffers S, Hoorntje JC, Suryapranata H, de Boer MJ, et al. Long-term recovery of left ventricular function after primary angioplasty for acute myocardial infarction. Eur Heart J. 2001 May;22(9):785-90.

Stolfo D, Cinquetti M, Merlo M, Santangelo S, Barbati G, Alonge M, et al. ST-elevation myocardial infarction with reduced left ventricular ejection fraction: Insights into persisting left ventricular dysfunction. A pPCI-registry analysis. Int J Cardiol. 2016;215:340-5.

Zijlstra F, Ernst N, de Boer MJ, Nibbering E, Suryapranata H, Hoorntje JC, et al. Influence of prehospital administration of aspirin and heparin on initial patency of the infarct-related artery in patients with acute ST elevation myocardial infarction. J Am Coll Cardiol. 2002 Jun 5;39(11):1733-7.

Verheugt FW, Liem A, Zijlstra F, Marsh RC, Veen G, Bronzwaer JG. High dose bolus heparin as initial therapy before primary angioplasty for acute myocardial infarction: results of the Heparin in Early Patency (HEAP) pilot study. J Am Coll Cardiol. 1998 Feb;31(2):289-93.

Chung WY, Han MJ, Cho YS, Kim KI, Chang HJ, Youn TJ, et al. Effects of the early administration of heparin in patients with ST-elevation myocardial infarction treated by primary angioplasty. Circ J. 2007 Jun;71(6):862-7.

Stone GW, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, et al. Bivalirudin during primary PCI in acute myocardial infarction. N Engl J Med. 2008 May 22;358(21):2218-30.

Bonello L, de Labriolle A, Roy P, Steinberg DH, Pinto Slottow TL, Xue Z, et al. Head-to-head comparison of bivalirudin versus heparin without glycoprotein IIb/IIIa inhibitors in patients with acute myocardial infarction undergoing primary angioplasty. Cardiovasc Revasc Med. 2009 Jul-Sep;10(3):156-61.

Steg PG, Van't Hof A, Hamm CW, Clemmensen P, Lapostolle F, Coste P, et al. Bivalirudin started during emergency transport for primary PCI. N Engl J Med. 2013 Dec 5;369(23):2207-17.

Montalescot G, Zeymer U, Silvain J, Boulanger B, Cohen M, Goldstein P, et al. Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the international randomised open-label ATOLL trial. Lancet. 2011 Aug 20;378(9792):693-703.




How to Cite

Zamani, B., Abdollahi, A., & Mardi, A. (2018). The effect of heparin prescription before primary PCI on long-term and short-term clinical and para clinical results and the mortality of patients with acute coronary syndrome. International Journal of Basic & Clinical Pharmacology, 7(4), 748–752.



Original Research Articles