Timing of aspirin administration as a determinant of survival of patients with acute myocardial infarction treated with thrombolysis

Freimark, Dov; Matetzky, Shlomo; Leor, Jonathan; Boyko, Valentina; Barbash, Israel M; Behar, Solomon; Hod, Hanoch

doi:10.1016/s0002-9149(01)02256-1

Cited by 111Acute Myocardial Infarction ResearchAntiplatelet Therapy and Cardiovascular DiseasesCardiac Ischemia and Reperfusion

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Timing of aspirin administration as a determinant of survival of patients with acute myocardial infarction treated with thrombolysis

Freimark, Dov, Matetzky, Shlomo, Leor, Jonathan, Boyko, Valentina, Barbash, Israel M, Behar, Solomon, Hod, Hanoch·2002·The American Journal of Cardiology

DOI 10.1016/s0002-9149(01)02256-1

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Abstract

Unlike thrombolytic agents, there are conflicting data regarding the time-dependent effect of aspirin treatment on outcome in acute myocardial infarction (AMI). We sought to evaluate the impact of timing of aspirin administration (before vs after thrombolysis) on mortality of patients with AMI. Our study included 1,200 patients with ST elevation AMI treated with thrombolysis. Early (n = 364) versus late (n = 836) users were defined as those receiving emergency aspirin before versus after initiation of thrombolysis, respectively. Time (median) from symptom onset to initiation of aspirin treatment was significantly shorter in early versus late users (1.6 vs 3.5 hours; p <0.001). There were no significant differences between the 2 groups with respect to baseline clinical characteristics. Early aspirin users were more likely to develop reischemia, to be treated with beta blockers, to be referred to coronary angiography, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft surgery. Early users experienced lower mortality at 7 days (2.5% vs 6.0%, p = 0.01), 30 days (3.3% vs 7.3%, p = 0.008), and 1 year (5.0% vs 10.6%, p = 0.002) than late users. This survival benefit persisted for patients with and without previous aspirin therapy or revascularization and after adjustment for baseline characteristics and therapies at 7 days (odds ratio 0.36, 95% confidence interval 0.15 to 0.79), at 30 days (odds ratio 0.39, 95% confidence interval 0.17 to 0.82), and at 1 year (odds ratio 0.41, 95% confidence interval 0.21 to 0.74). Our study proposes a time-dependent benefit from aspirin in patients with AMI treated with thrombolysis.

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Aspirin's effect has been shown to be greater when administered earlier after symptom onset.
“Furthermore, its effect has been shown to be greater when administered earlier after symptom onset.5”
From Prehospital Administration of Aspirin and Nitroglycerin for Patients With Suspected Acute Coronary Syndrome ― A Systematic Review ― (2022) · cites this paper as [5]

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1988, Randomised trial of intravenous streptokinase oral aspirin both, or neither among 17,187 cases of suspected acute myocardial infarction, Lancet, 2, 349

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Selatogrel for Acute Myocardial Infarction
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T HE E FFECT OF S IMPLE I NTERVENTIONS ON P ARAMEDIC A SPIRIN A DMINISTRATION R ATES
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Initiales Management des akuten Koronarsyndroms
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34 The Pre-Hospital Electrocardiogram
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Erste Hilfe
Zideman, D. A., Buck, E. D. J. D., Singletary, E. M., Cassan, P., Chalkias, A. F., Evans, T. R., Hafner, C. M., Handley, A. J., Meyrán, D., Schunder-Tatzber, S., et al. (2015) · Notfall + Rettungsmedizin · doi:10.1007/s10049-015-0093-x · Cited by 1
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Sinnaeve, P., & de Werf, F. V. (2012) · doi:10.1002/9781118410875.ch13
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Sethi, A., & Arora, R. R. (2015) · Current research. Cardiology · doi:10.4172/2368-0512.1000034
Épidémiologie des arrêts cardiaques extrahospitaliers recensés en Basse-Normandie par le registre RéAC
Zamparini, G., Buléon, C., Bonnieux, D., Régent, H. D. F., Oriot, G., Rebet, O., Afandi, B. A., Arrot, X., Soulier, A.-S. G., Halbout, L., et al. (2014) · Annales Françaises d Anesthésie et de Réanimation · doi:10.1016/j.annfar.2014.10.015
Chest pain and acute coronary syndrome
Ornato, J. P., Sayre, M. R., & Syrett, J. I. (2015) · Emergency medical services · doi:10.1002/9781118990810.ch13
Care Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Part 10: Acute Coronary Syndromes: 2010 American Heart Association
Yannopoulos, D., Ghaemmaghami, C. A., Menon, V., O’Neil, B. J., Travers, A. H., O’Connor, R. E., Brady, W. J., Brooks, S. C., & Diercks, D. (2010)
Comparison of educational effectiveness between lecture and demonstration based methods on emergency medical services providers of Mashhad city in dealing with patients suspected of having acute coronary syndrome
Bolvardi, E., Reihani, H., Pishbin, E., Abdolrahim, S., & Mohsen, E. (2014)
Traducción oficial autorizada al español del Consejo Español de Resucitación Cardiopulmonar (CERCP)
Monsieurs, K. G., Nolan, J. P., Bossaert, L. L., Greif, R. T., Maconochie, I. K., Nikolaou, N. I., Perkins, G. D., Soar, J., Wyllie, J. P., & Zideman, D. A. (2015)
Bei dem folgenden Dokument handelt es sich um eine nicht finale Übersetzung der European Resuscitation Council (ERC) Guidelines for Resuscitation 2010. Die finale und durch den European Resuscitation Council, German Resuscitation Council und Austrian Resuscitation Council autorisierte Übersetzung erscheint Ende November in Notfall +
Nolan, J. P., Soar, J., Zideman, D. A., Biarent, D., Bossaert, L. L., Deakin, C. D., Koster, R. W., Wyllie, J. P., Böttiger, B. W., & Senior, H. (2010)
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Part 10: Acute Coronary Syndromes: 2010 American Heart Association Guidelines for
O’Connor, R. E., Brady, W. J., Brooks, S. C., Diercks, D., & Egan, J. R. (2013)
Chest Pain of Suspected Cardiac Origin: Current Evidence-based Recommendations for
Brian, P., JOHN, F. B. S., & Kristi, L. (2015)
Smernice za oživljanje 2010 Evropskega sveta za reanimacijo Del 1. Izvršni povzetek
Nolan, J. P., Soar, J., Zideman, D. A., Biarent, D., Bossaert, L. L., Deakin, C. D., Koster, W., & Wyllie, J. P. (2010)

Aspirin in AMI — The Sooner, the Better
Bukata, W. R. (2002) · Emergency Medicine News · doi:10.1097/01.eem.0000334458.25555.57
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., et al. (2002) · Cardiology · doi:10.1159/000066324 · Cited by 104
Self-citation
Is the Timing of Treatment Critical?
Tognoni, G. (2008) · Cardiology · doi:10.1159/000176750 · Cited by 1
Thrombolysis for acute myocardial infarction: drug review.
Cundiff, D. K. (2002) · PubMed · Cited by 9
Role of Aspirin with Thrombolytic Therapy in Acute Myocardial Infarction
Hennekens, C. H. (1990) · CHEST Journal · doi:10.1378/chest.97.4.151s · Cited by 11

Authors: Freimark, D., Matetzky, S., Leor, J., Boyko, V., Barbash, I. M., Behar, S., & Hod, H.
Affiliations: Tel Aviv University (IL)
Corresponding author: Leor, Jonathan
ORCID: Leor, Jonathan
Barbash, Israel M
Venue: The American Journal of Cardiology
Publisher: Elsevier BV
Published: 2002-02
Volume: 89
Issue: 4
Pages: 381-385
ISSN: 0002-9149 (ISSN-L)
DOI: 10.1016/s0002-9149(01)02256-1
OpenAlex: W2004590941
Cited by: 111
References: 16
Citations by year: 2026: 3 · 2025: 1 · 2024: 3 · 2023: 1 · 2022: 4 · 2021: 6 · 2020: 10 · 2019: 3 · 2018: 4 · 2017: 3 · 2016: 3 · 2015: 21 · 2014: 3 · 2013: 3 · 2012: 5
FWCI: 2.62
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The American Journal of Cardiology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Ischemia and Reperfusion
Keywords: aspirin, acute myocardial infarction, thrombolysis, ST-elevation myocardial infarction, timing of drug administration, mortality, beta-blockers, revascularization, coronary angioplasty, coronary artery bypass grafting
MeSH terms: Aged, Anti-Inflammatory Agents, Non-Steroidal, Aspirin, Female, Humans, Male, Middle Aged, Myocardial Infarction, Thrombolytic Therapy, Survival Analysis, Randomized Controlled Trials as Topic

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Timing of aspirin administration as a determinant of survival of patients with acute myocardial infarction treated with thrombolysis

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