Influence of prehospital administration of aspirin and heparin on initial patency of the infarct-related artery in patients with acute ST elevation myocardial infarction.
OBJECTIVE
The aim of this study was to investigate the influence of prehospital administration of aspirin and heparin on the initial patency of the infarct-related artery (IRA) in patients with acute myocardial infarction (MI).


BACKGROUND
Prehospital diagnosis of acute MI facilitates early pharmacologic intervention on the way to the catheterization laboratory for primary angioplasty.


METHODS
We studied the angiographic data and 30-day clinical outcome of 1,702 patients treated with primary angioplasty; 860 received aspirin and heparin before transportation to our hospital and 842 received aspirin and heparin in our hospital.


RESULTS
The Thrombolysis In Myocardial Infarction (TIMI) 2 or 3 flow in the IRA was higher in the prehospital treated group (31% vs. 20%, relative risk 0.65, 95% confidence interval 0.55 to 0.78, p < 0.001). Patients with TIMI 2 or 3 flow on the initial angiogram had a higher angioplasty success rate (94% vs. 89%, p < 0.001), a smaller enzymatic infarct size, a higher left ventricular ejection fraction and a lower 30-day mortality (1.6% vs. 3.4%, p = 0.04).


CONCLUSIONS
Prehospital administration of aspirin and heparin results in a higher initial patency of the IRA in patients with acute MI.
Zijlstra
Felix
F
Department of Cardiology, Isala Klinieken lokatie de Weezenlanden, Groot Wezenland 20, 8011 JW Zwolle, the Netherlands. f.zijlstra@diagram-zwolle.nl
Ernst
Nicolette
N
de Boer
Menko-Jan
MJ
Nibbering
Edwin
E
Suryapranata
Harry
H
Hoorntje
Jan C A
JC
Dambrink
Jan-Henk E
JH
van 't Hof
Arnoud W J
AW
Verheugt
Freek W A
FW
D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000627:therapeutic use*; D017023:Coronary Angiography; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D004632:Emergency Medical Services; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy
D005343:Fibrinolytic Agents; D006493:Heparin; D001241:Aspirin