Journal Mobile Options
Table of Contents
Vol. 98, No. 3, 2002
Issue release date: November 2002
Cardiology 2002;98:141–147

Outcome of Myocardial Infarction in Patients Treated with Aspirin Is Enhanced by Pre-Hospital Administration

Barbash 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

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


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.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Boersma E, Maas AC, Deckers JW, et al: Early thrombolytic treatment in acute myocardial infarction: Reappraisal of the golden hour. Lancet 1996;348:771–775.
  2. Ellerbeck EF, Jencks SF, Radford MJ, et al: Quality of care for Medicare patients with acute myocardial infarction. A four-state pilot study from the Cooperative Cardiovascular Project. JAMA 1995;273:1509–1514.
  3. Rogers WJ, Bowlby LJ, Chandra NC, et al: Treatment of myocardial infarction in the United States (1990 to 1993). Observations from the National Registry of Myocardial Infarction. Circulation 1994;90:2103–2114.
  4. Saketkhou BB, Conte FJ, Noris M, et al: Emergency department use of aspirin in patients with possible acute myocardial infarction. Ann Intern Med 1997;127:126–129.
  5. The Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators: Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001;345:494–502.
  6. Zijlstra F, Ernst N, de Boer MJ, 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;39:1733–1737.
  7. Stone GW, Cox D, Garcia E, et al: Normal flow (TIMI-3) before mechanical reperfusion therapy is an independent determinant of survival in acute myocardial infarction: Analysis from the primary angioplasty in myocardial infarction trials. Circulation 2001;104:636–641.

    External Resources

  8. Fitzgerald DJ, Catella F, Roy L, et al: Marked platelet activation in vivo after intravenous streptokinase in patients with acute myocardial infarction. Circulation 1988;77:142–150.
  9. Roux S, Christeller S, Lüdin E: Effects of aspirin on coronary reocclusion and recurrent ischemia after thrombolysis: A meta-analysis. J Am Coll Cardiol 1992;19:671–677.
  10. SAS/STAT User’s Guide, ed 4, version 6. Cary, SAS Institute, 1989.
  11. Behar S, Battler A, Porath A, et al, for the Israeli Heart and Internal Medicine Societies: The Israeli national prospective survey on acute myocardial infarction in 2000. J Isr Heart Soc 2001;11:45–48.
  12. Freimark D, Matetzki S, Leor J, Boyko V, Barbash IM, Behar S, Hod H: Timing of aspirin administration as a determinant of survival of patients with acute myocardial infarction treated with thrombolysis. Am J Cardiol 2002;89:381–385.
  13. Awtry EH, Loscalzo J: Aspirin. Circulation 2000;101:1206–1218.
  14. Becker RC, Burns M, Gore JM, et al: Early and pre-discharge aspirin administration among patients with acute myocardial infarction: Current clinical practice and trends in the United States. J Thromb Thrombolysis 2000;9:207–215.
  15. The pre-hospital management of acute heart attacks. Recommendations of a Task Force of the European Society of Cardiology and the European Resuscitation Council. Eur Heart J 1998;19:1140–1164.
  16. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group: Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988;ii:349–360.
  17. Simoons ML: Selection of reperfusion therapy for individual patients with evolving myocardial infarction. Eur Heart J 1997;18:1371–1381.
  18. Ryan TJ, Antman EM, Brooks NH, et al: 1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction: Executive summary and recommendations: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation 1999;100:1016–1030.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50