Outcome of Myocardial Infarction in Patients Treated with Aspirin Is Enhanced by Pre-Hospital AdministrationBarbash I.M. · Freimark D. · Gottlieb S. · Hod H. · Hasin Y. · Battler A. · Crystal E. · Matetzky S. · Boyko V. · Mandelzweig L. · Behar S. · Leor J.
aNeufeld Cardiac Research Institute, Tel-Aviv University, Sheba Medical Center, Tel-Hashomer, and bCardiology Department, Rabin Medical Center, Petah-Tikva, Israel
Objective: Reducing time to reperfusion therapy is one of the goals in the management of acute myocardial infarction (AMI). We assessed the association between timing of aspirin administration and outcome of patients with AMI. Patients: We studied 922 consecutive AMI patients with ST-segment elevation in Killip class I–III on admission. Patients were divided into two groups based upon the timing of emergency aspirin administration: before (early aspirin users) or after (late aspirin users) hospital admission. Results: Early aspirin users (n = 338; 37%) were younger, less likely to be women, and more likely to smoke (p < 0.006) than late users (n = 584; 63%). Other baseline and clinical characteristics were similar. Early aspirin users were more likely to be treated with thrombolysis or primary percutaneous transluminal coronary angioplasty. Compared with late users, early aspirin users had significantly lower in-hospital complications and lower mortality rates at 7 (2.4 vs. 7.3%, p = 0.002) and 30 days (4.9 vs. 11.1%, p = 0.001). By multivariate adjustment, pre-hospital aspirin was an independent determinant of survival at 7 (odds ratio 0.43; 95% confidence interval 0.18–0.92) and at 30 days (odds ratio, 0.60; 95% confidence interval 0.32–1.08). Survival benefit associated with aspirin persisted for subgroups treated or not with reperfusion therapy. Conclusions: Outcome of AMI patients treated with aspirin is improved by pre-hospital administration.Our findings suggest that emergency pre-hospital aspirin might facilitate early reperfusion.
Jonathan Leor, MD, FACC
Neufeld Cardiac Research Institute, Sheba Medical Center
Tel-Hashomer 52621 (Israel)
Tel. +972 3 534 2278, Fax +972 3 535 1139, E-Mail firstname.lastname@example.org
Received: Received: February 16, 2002
Accepted after revision: July 29, 2002
Number of Figures : 0, Number of Tables : 5, Number of References : 18
Cardiology (International Journal of Cardiovascular Medicine, Surgery and Pathology)
Founded 1937 as ‘Cardiologia’ by Bruno Kisch and Wilhelm Löffler
Vol. 98, No. 3, Year 2002 (Cover Date: Released November 2002)
Journal Editor: Joseph S. Alpert, Tucson, Ariz.
ISSN: 0008–6312 (print), 1421–9751 (Online)
For additional information: http://www.karger.com/journals/crd