title: Influence of prehospital administration of aspirin and heparin on initial patency of the infarct-related artery in patients with acute ST elevation myocardial infarction.
abstract: 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.
authors.affiliation: Department of Cardiology, Isala Klinieken lokatie de Weezenlanden, Groot Wezenland 20, 8011 JW Zwolle, the Netherlands. f.zijlstra@diagram-zwolle.nl
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.forename: Nicolette
authors.initials: N
authors.lastname: Ernst
authors.forename: Menko-Jan
authors.initials: MJ
authors.lastname: de Boer
authors.forename: Edwin
authors.initials: E
authors.lastname: Nibbering
authors.forename: Harry
authors.initials: H
authors.lastname: Suryapranata
authors.forename: Jan C A
authors.initials: JC
authors.lastname: Hoorntje
authors.forename: Jan-Henk E
authors.initials: JH
authors.lastname: Dambrink
authors.forename: Arnoud W J
authors.initials: AW
authors.lastname: van 't Hof
authors.forename: Freek W A
authors.initials: FW
authors.lastname: Verheugt
mesh_terms: 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
chemical_list: D005343:Fibrinolytic Agents; D006493:Heparin; D001241:Aspirin