{"id":139808,"date":"2026-04-01T16:52:56","date_gmt":"2026-04-01T20:52:56","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=139808"},"modified":"2026-04-01T16:52:57","modified_gmt":"2026-04-01T20:52:57","slug":"prehospital-heparin-improves-coronary-patency-in-stemi-without-excess-bleeding-ufh-stemi-trial","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=139808","title":{"rendered":"Prehospital Heparin Improves Coronary Patency in STEMI Without Excess Bleeding: UFH-STEMI Trial"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Key Points<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The UFH-STEMI Trial conducted in Slovenia demonstrated that prehospital UFH (70-100 IU\/kg) at first medical contact significantly increased infarct-related artery patency at initial angiography compared with standard of care.<\/li>\n\n\n\n<li>The primary safety endpoint, major bleeding (BARC 3-5), did not differ between groups.<\/li>\n\n\n\n<li>Other variables such as ST-segment resolution and 24-hour troponin levels favored prehospital heparin, suggesting reduced myocardial injury.<\/li>\n<\/ul>\n\n\n\n<p>Unfractionated heparin is standard anticoagulation during primary PCI for STEMI, but optimal timing of administration has remained uncertain. The UFH-STEMI trial (<a href=\"https:\/\/clinicaltrials.gov\/study\/NCT05247424\">NCT05247424<\/a>), presented at ACC.26 and simultaneously published in <a href=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.126.079839\">Circulation<\/a>, tested whether a weight-adjusted UFH bolus at prehospital first medical contact would improve coronary patency compared with standard administration at the time of PCI.<\/p>\n\n\n\n<p>UFH-STEMI was an investigator-initiated, single-center, open-label randomized trial conducted at University Medical Centre Ljubljana, Slovenia, from March 2022 to February 2025. Patients with STEMI confirmed at prehospital first medical contact and symptom duration under 6 hours were randomized 1:1 to UFH pretreatment (70-100 IU\/kg IV bolus at first medical contact; n=298) or standard care (UFH after initial angiography; n=295). Patients in cardiogenic shock and cardiac arrest survivors were excluded. The primary efficacy endpoint was TIMI 2-3 flow in the infarct-related artery at initial angiography; the primary safety endpoint was BARC 3-5 bleeding.<\/p>\n\n\n\n<p>The population was typical for contemporary STEMI: mean age 64 years, 74% male, 17% diabetic, and 52% hypertensive. Median time from symptom onset to angiography was similar between groups (145 vs. 150 minutes; p=0.814). Median time from prehospital UFH to angiography was 60 minutes. Radial access was used in 78% of cases, and PCI with stenting was performed in over 95%.<\/p>\n\n\n\n<p>The primary efficacy endpoint occurred in 42.6% of the UFH pretreatment group versus 26.7% of controls (RR 1.59; 95% CI, 1.27-1.98; p&lt;0.001); an absolute difference of 16 percentage points. TIMI 3 flow was present in 23.0% versus 13.7%, respectively. Critically, this benefit came without a safety tradeoff: BARC 3-5 bleeding occurred in 2.4% versus 2.0% (p=0.789). Findings were consistent in per-protocol and as-treated sensitivity analyses.<\/p>\n\n\n\n<p>Secondary endpoints supported potential downstream benefits of improved early patency. ST-segment resolution was better with pretreatment (65% vs. 59%; p=0.047), and 24-hour troponin was significantly lower (30,357 vs. 41,795 ng\/L; p=0.036), suggesting reduced myocardial injury. Final TIMI 3 flow post-PCI was similar in both groups (81% vs. 81%). The study was not powered for clinical endpoints; 30-day mortality (2.4% vs. 2.5%) and 1-year mortality (4.1% vs. 2.8%) did not differ significantly.<\/p>\n\n\n\n<p>These findings align with the recent HELP-PCI trial from China, which also showed improved patency with early heparin, though with smaller absolute benefit (32% vs. 28% for TIMI 2-3 flow). The larger effect in UFH-STEMI may reflect shorter symptom-to-contact times in the Slovenian cohort (70 vs. 161 minutes), catching thrombus at a less organized, more heparin-sensitive stage. Patency rates matched those achieved with bivalirudin or abciximab pretreatment, but without the excess bleeding associated with those agents.<\/p>\n\n\n\n<p>Limitations include single-center design within a mature STEMI network, exclusion of high-risk patients, and insufficient power for clinical endpoints. Prespecified subgroup analyses showed consistent treatment effects across sex, age, culprit artery, and access site, with no significant interactions.<\/p>\n\n\n\n<p>Dr. Misa Fister, the study&#8217;s lead investigator, stated: &#8220;We found a 16% absolute difference in the patency of infarct-related arteries. The primary safety endpoint was bleeding and there was no significant difference between the groups. UFH pretreatment at first medical contact is easy, safe, and cheap.&#8221;<\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Key Points Unfractionated heparin is standard anticoagulation during primary PCI for STEMI, but optimal timing of administration has remained uncertain. The UFH-STEMI trial (NCT05247424), presented at ACC.26 and simultaneously published in Circulation, tested whether a weight-adjusted UFH bolus at prehospital first medical contact would improve coronary patency compared with standard administration at the time of [&hellip;]<\/p>\n","protected":false},"author":40604,"featured_media":139809,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"aside","meta":{"footnotes":""},"categories":[1074,8],"tags":[1075,45,47,185],"ppma_author":[1031],"class_list":{"0":"post-139808","1":"post","2":"type-post","3":"status-publish","4":"format-aside","5":"has-post-thumbnail","7":"category-acc-2026","8":"category-news","9":"tag-acc-2026","10":"tag-conference","11":"tag-featured","12":"tag-news","13":"post_format-post-format-aside","14":"author-basir-gill"},"authors":[{"term_id":1031,"user_id":40604,"is_guest":0,"slug":"basir-gill","display_name":"Basir Gill MD","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/05064ea2c277f8906826ab0662151459a584dc4b50046758e59dbf39135256c6?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/139808","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40604"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=139808"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/139808\/revisions"}],"predecessor-version":[{"id":139810,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/139808\/revisions\/139810"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/139809"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=139808"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=139808"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=139808"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=139808"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}