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Determinants of pre-hospital pharmacological intervention and its association with outcome in acute myocardial infarction
Open accessAbstract
BACKGROUND: The aim of this study was a) To identify predictors of the use of aspirin in the pre-hospital setting in acute myocardial infarction (AMI) and b) To analyze whether the use of any of the recommended medications was associated with outcome. METHODS: All patients with a final diagnosis of AMI, transported by the Emergency Medical Services (EMS) and admitted to the coronary care unit at Sahlgrenska University Hospital in Gothenburg, Sweden, in 2009-2011, were included. RESULTS: 1,726 patients were included. 58 % received aspirin by the EMS. Ischemic heart disease (IHD) was suspected in 84 %. Among patients who did not receive aspirin IHD was still suspected in 67 %. Among patients in whom IHD was suspected, and who were not on chronic treatment with aspirin the following predicted its pre-hospital use: a) age (odds ratio 0.98; 95 % confidence interval (CI) 0.96-0.99); b) a history of myocardial infarction (2.21; 1.21-4.04); c) priority given by EMS (8.07; 5.42-12.02); d) ST-elevation on ECG on admission to hospital (2.22; 1.50-3.29); e) oxygen saturation > 90 % (3.37; 1.81-6.27). After adjusting for confounders among patients who were not on chronic aspirin, only nitroglycerin of the recommended medications was associated with a reduced risk of death within 1 year (hazard ratio 0.40; 95 % CI 0.23-0.70). CONCLUSIONS: Less than six out of ten patients with AMI received pre-hospital aspirin. Five clinical factors were independently associated with the pre-hospital administration of aspirin. This suggests that the decision to treat is multifactorial, and it highlights the lack of accurate diagnostic tools in the pre-hospital environment. Nitroglycerin was independently associated with a reduced risk of death, suggesting that we select the use for a low-risk cohort.
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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 [17]
The Results section reports lower one-year mortality among patients given prehospital aspirin than among those not given it (10.1% versus 18.6%; p = 0.009). Our copy does not report the claimed 30-day odds ratio of 0.59 (95% CI 0.35–0.99), nor does that result compare prehospital aspirin with aspirin given after hospital arrival. The Abstract’s Results also state that, after adjustment, only nitroglycerin was associated with reduced one-year mortality. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPrehospital nitroglycerin administration by non-physician healthcare professionals to patients with suspected ACS/AMI is associated with significantly lower 30-day mortality compared with no prehospital nitroglycerin administration (OR 0.34, 95% CI 0.24-0.50).
“Prehospital nitroglycerin administration was also associated with significantly lower 30-day and 1-year mortality compared with no prehospital administration (OR 0.34 [95% CI 0.24–0.50] and 0.38 [95% CI 0.29–0.50], respectively).”
From Prehospital Administration of Aspirin and Nitroglycerin for Patients With Suspected Acute Coronary Syndrome ― A Systematic Review ― (2022) · cites this paper as [17]
The Discussion (Predictors of death; page not provided) reports that prehospital nitrate use was associated with a reduced risk of death after adjustment for confounders. The cited paper does not report the claimed 30-day mortality OR of 0.34 (95% CI 0.24–0.50); its Abstract (Results; page not provided) instead reports a one-year hazard ratio of 0.40 (95% CI 0.23–0.70) among patients not on chronic aspirin. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPrehospital aspirin administration by non-physician healthcare professionals to patients with suspected ACS/AMI is associated with significantly lower 1-year mortality compared with no prehospital aspirin administration (OR 0.47, 95% CI 0.36-0.62).
“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 [17]
The Results section reports lower one-year mortality among patients given prehospital aspirin than among those not given it (10.1% versus 18.6%; p = 0.009). It does not report the claimed odds ratio of 0.47, a comparison specifically with aspirin given after hospital arrival, or the cited 30-day result. The Results also state that, after adjustment for confounders, only nitroglycerin was associated with reduced one-year mortality. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPrehospital nitroglycerin administration by non-physician healthcare professionals to patients with suspected ACS/AMI is associated with significantly lower 1-year mortality compared with no prehospital nitroglycerin administration (OR 0.38, 95% CI 0.29-0.50).
“Prehospital nitroglycerin administration was also associated with significantly lower 30-day and 1-year mortality compared with no prehospital administration (OR 0.34 [95% CI 0.24–0.50] and 0.38 [95% CI 0.29–0.50], respectively).”
From Prehospital Administration of Aspirin and Nitroglycerin for Patients With Suspected Acute Coronary Syndrome ― A Systematic Review ― (2022) · cites this paper as [17]
The Discussion (‘Predictors of death’) reports that prehospital nitrate use was associated with a reduced risk of death after adjustment for confounders. But the reported one-year estimate is a hazard ratio of 0.40 (95% CI 0.23–0.70) among patients not on chronic aspirin, not the claimed odds ratio of 0.38 (95% CI 0.29–0.50). The retrieved passages do not report the cited 30-day estimate. (LLM, conf=0.90)
Experimental — accuracy not yet measuredNo 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 [17]
No RCTs were identified for nitroglycerin; only 1 non-RCT was identified.
“There were no RCTs, and only 1 non-RCT was identified.17”
From Prehospital Administration of Aspirin and Nitroglycerin for Patients With Suspected Acute Coronary Syndrome ― A Systematic Review ― (2022) · cites this paper as [17]
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Metadata
- Authors
- Strandmark, R., Herlitz, J., Axelsson, C., Claesson, A., Bremer, A., Karlsson, T., Jimenez-Herrera, M., & Ravn-Fischer, A.
- Affiliations
- Sahlgrenska University Hospital (SE)
- University of Borås (SE)
- Karolinska Institutet (SE)
- University of Gothenburg (SE)
- Corresponding author
- Strandmark, Rasmus
- ORCID
- Venue
- Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
- Published
- 2015-12
- Volume
- 23
- Issue
- 1
- Pages
- 105-105
- ISSN
- 1757-7241 (ISSN-L)
- PMC
- PMC4665872
- OpenAlex
- W2181525576
- Cited by
- 16
- References
- 31
- Citations by year
- 2026: 1 · 2024: 6 · 2023: 1 · 2022: 4 · 2021: 1 · 2020: 1 · 2018: 1 · 2016: 1
- FWCI
- 0.49
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Scandinavian Journal of Trauma Resuscitation and Emergency Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Keywords
- acute myocardial infarction, prehospital care, aspirin, emergency medical services, nitroglycerin, predictors of medication use, ischemic heart disease, ST-segment elevation, oxygen saturation, one-year mortality
- MeSH terms
- Clopidogrel, Adrenergic beta-Antagonists, Aged, Analgesics, Opioid, Anticoagulants, Aspirin, Electrocardiography, Emergency Medical Services, Female, Nitroglycerin, Humans, Male, Morphine, Myocardial Infarction, Oxygen, Platelet Aggregation Inhibitors, Sweden, Ticlopidine, Vasodilator Agents, Treatment Outcome
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