CLINICAL STUDY
Influence of prehospital administration of aspirin and heparin on initial patency of the infarct-related artery in patients with acute st elevation myocardial infarction
Felix Zijlstra, MD, PhD*,*,
Nicolette Ernst, MD*,
Menko-Jan de Boer, MD, PhD*,
Edwin Nibbering*,
Harry Suryapranata, MD, PhD, FACC*,
Jan C. A. Hoorntje, MD, PhD*,
Jan-Henk E. Dambrink, MD, PhD*,
Arnoud W. J. van’t Hof, MD, PhD* and
Freek W. A. Verheugt, MD, PhD
* Department of Cardiology, Hospital De Weezenlanden, Zwolle, Netherlands
Department of Cardiology, University Hospital, Nijmegen, Netherlands
Manuscript received October 18, 2001;
revised manuscript received February 26, 2002,
accepted March 1, 2002.
* Reprint requests and correspondence: Dr. Felix Zijlstra, Isala Klinieken, Hospital De Weezenlanden, Department of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, Netherlands.
f.zijlstra{at}diagram-zwolle.nl
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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Abbreviations and Acronyms
| | HEAP | | Heparin in Early Patency trial | | IRA | | infarct-related artery | | LDHQ48 | | enzymatic infarct size from serial measurements of lactate dehydrogenase | | LVEF | | left ventricular ejection fraction | | MI | | myocardial infarction | | TIMI | | Thrombolysis In Myocardial Infarction |
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