Influence of prehospital administration of aspirin and heparin on initial patency of the infarct-related artery in patients with acute st elevation myocardial infarction

Zijlstra, Felix; Ernst, Nicolette; de Boer, Menko-Jan; Nibbering, Edwin; Suryapranata, Harry; Hoorntje, Jan C.A; Dambrink, Jan-Henk E; van’t Hof, Arnoud W.J; Verheugt, Freek W.A

doi:10.1016/s0735-1097(02)01856-9

Cited by 131Acute Myocardial Infarction ResearchCoronary Interventions and DiagnosticsAntiplatelet Therapy and Cardiovascular Diseases

The DOI matches its Crossref record; 24 of the 24 references it cites were found in a registry or an index.

Influence of prehospital administration of aspirin and heparin on initial patency of the infarct-related artery in patients with acute st elevation myocardial infarction

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Zijlstra, Felix, Ernst, Nicolette, de Boer, Menko-Jan, Nibbering, Edwin, Suryapranata, Harry, Hoorntje, Jan C.A, Dambrink, Jan-Henk E, van’t Hof, Arnoud W.J, Verheugt, Freek W.A·2002·Journal of the American College of Cardiology

DOI 10.1016/s0735-1097(02)01856-9

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Abstract

Objectives 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.

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There was no significant difference in stroke between prehospital aspirin administration and control groups.
“For the critical outcome of reinfarction and stroke, and for the important outcome of major hemorrhage, there were no significant differences between the prehospital administration and control groups.”
From Prehospital Administration of Aspirin and Nitroglycerin for Patients With Suspected Acute Coronary Syndrome ― A Systematic Review ― (2022) · cites this paper as [15]
Prehospital aspirin administration by non-physician healthcare professionals to patients with suspected ACS/AMI is associated with significantly lower 30-day mortality compared with no prehospital aspirin administration (OR 0.59, 95% CI 0.35-0.99).
“Prehospital aspirin administration was associated with significantly lower 30-day and 1-year mortality compared with aspirin administration after arrival at hospital, with odds ratios (OR) of 0.59 (95% confidence interval [CI] 0.35–0.99) and 0.47 (95% CI 0.36–0.62), respectively.”
From Prehospital Administration of Aspirin and Nitroglycerin for Patients With Suspected Acute Coronary Syndrome ― A Systematic Review ― (2022) · cites this paper as [15]
There was no significant difference in major hemorrhage between prehospital aspirin administration and control groups.
“For the critical outcome of reinfarction and stroke, and for the important outcome of major hemorrhage, there were no significant differences between the prehospital administration and control groups.”
From Prehospital Administration of Aspirin and Nitroglycerin for Patients With Suspected Acute Coronary Syndrome ― A Systematic Review ― (2022) · cites this paper as [15]
No RCTs were identified for aspirin; all 3 included citations were non-RCTs.
“No RCTs were identified, and all 3 identified citations were non-RCTs.15–17”
From Prehospital Administration of Aspirin and Nitroglycerin for Patients With Suspected Acute Coronary Syndrome ― A Systematic Review ― (2022) · cites this paper as [15]

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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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988-6 Influence of Pre-Hospital Heparinisation on Early Patency Rate of Infarct Related Artery in Acute Myocardial Infarction
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Parenteral Anticoagulation at First Medical Contact Improves Infarct Related Artery Patency in STEMI
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Authors: Zijlstra, F., Ernst, N., de Boer, M.-J., Nibbering, E., Suryapranata, H., Hoorntje, J. C. A., Dambrink, J.-H. E., van’t Hof, A. W. J., & Verheugt, F. W. A.
Affiliations: Isala (NL)
Corresponding author: Zijlstra, Felix
ORCID: Zijlstra, Felix
de Boer, Menko-Jan
Suryapranata, Harry
Verheugt, Freek W.A
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2002-06
Volume: 39
Issue: 11
Pages: 1733-1737
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/s0735-1097(02)01856-9
OpenAlex: W2008443325
Cited by: 131
References: 24
Citations by year: 2026: 2 · 2025: 4 · 2024: 5 · 2023: 3 · 2022: 6 · 2021: 2 · 2020: 6 · 2019: 1 · 2018: 3 · 2017: 2 · 2015: 10 · 2014: 2 · 2013: 1 · 2012: 3
FWCI: 7.00
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 4063 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
Radboud Repository (Radboud University) (submittedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Interventions and Diagnostics
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
Keywords: acute ST-elevation myocardial infarction, infarct-related artery patency, TIMI flow, primary percutaneous coronary intervention, prehospital thrombolysis, 30-day mortality, left ventricular ejection fraction
MeSH terms: Aspirin, Drug Therapy, Combination, Electrocardiography, Emergency Medical Services, Fibrinolytic Agents, Heparin, Humans, Middle Aged, Myocardial Infarction, Angioplasty, Balloon, Coronary, Coronary Angiography

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Influence of prehospital administration of aspirin and heparin on initial patency of the infarct-related artery in patients with acute st elevation myocardial infarction

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