Prehospital administration of ASA and UFH by emergency physicians did not significantly change in-hospital mortality (OR 0.813 for ASA, OR 1.036 for UFH) or bleeding rates (OR 1.142 for ASA, OR 1.053 for UFH) in patients with suspected myocardial infarction.
Cohort (n=2,756)
No
Does prehospital administration of acetylsalicylic acid and unfractionated heparin improve in-hospital mortality or bleeding in patients with suspected myocardial infarction?
Routine prehospital administration of aspirin and unfractionated heparin in patients with suspected myocardial infarction does not significantly improve in-hospital mortality or bleeding outcomes.
Effect estimate: OR 0.813 for ASA mortality, OR 1.036 for UFH mortality; OR 1.142 for ASA bleeding, OR 1.053 for UFH bleeding (95% CI 95% CI 0.453 to 1.461 for ASA mortality; 0.566 to 1.898 for UFH mortality; 0.762 to 2.615 for ASA bleeding; 0.558 to 1.986 for UFH bleeding)
p-value: p=0.489 for ASA mortality; p=0.908 for UFH mortality; p=0.273 for ASA bleeding; p=0.874 for UFH bleeding
Purpose: In a prehospital setting with limited diagnostic resources, identification of myocardial infarction (MI) can be challenging. However, high diagnostic accuracy of patients with MI is not only necessary to provide early revascularization but also essential to guide prehospital pharmacological therapy. Even though prehospital use of acetylsalicylic acid (ASA) and anticoagulation therapy is widely established, guidelines only recommend these medications in confirmed cases undergoing PCI. This study examines if prehospital treatment with ASA and unfractionated heparin (UFH) influences in-hospital mortality and bleeding rates in patients with suspected MI. Patients and Methods: In this retrospective, single-center cohort study, prehospital treatment with ASA and UFH in 2756 patients with suspected MI was analyzed. Associations between ASA/UFH and death/bleeding until discharge were investigated. To adjust for possible confounders, multiple logistic regression was performed. Furthermore, stepwise logistic regression was carried out in order to investigate factors that influence emergency physicians (EPs) decision to treat with ASA and UFH. Results: Prehospitally administered ASA and UFH was not associated with a significant change in mortality (odds ratio OR, 0.813; 95% confidence interval CI 0.453 to 1.461; p =0.489 for ASA and OR 1.036; CI 0.566 to 1.898; p =0.908 for UFH) or bleeding (OR, 1.142; 95% CI 0.762 to 2.615; p =0.273 for ASA and OR 1.053; CI 0.558 to 1.986; p =0.874 for UFH). Several factors including the presence of ST elevations, atypical chest pain, and concomitant medication were found to influence the EPs decision to treat with ASA and UFH. Conclusion: Prehospital administration of ASA and UFH did not affect in-hospital mortality and bleeding outcomes in a cohort of patients with suspected MI. These findings suggest that routine prehospital anticoagulation in suspected MI may not improve short-term outcomes and should be reconsidered pending randomized evidence. Keywords: Prehospital ACS, myocardial infarction, heparin, acetylsalicylic acid
Faller et al. (Sun,) conducted a cohort in Patients with suspected myocardial infarction in a prehospital emergency setting in Germany (n=2,756). Prehospital administration of acetylsalicylic acid (ASA) and unfractionated heparin (UFH) by emergency physician vs. No prehospital ASA and UFH administration was evaluated on In-hospital mortality and bleeding event (BARC II–V) until discharge (OR 0.813 for ASA mortality, OR 1.036 for UFH mortality; OR 1.142 for ASA bleeding, OR 1.053 for UFH bleeding, 95% CI 95% CI 0.453 to 1.461 for ASA mortality; 0.566 to 1.898 for UFH mortality; 0.762 to 2.615 for ASA bleeding; 0.558 to 1.986 for UFH bleeding, p=p=0.489 for ASA mortality; p=0.908 for UFH mortality; p=0.273 for ASA bleeding; p=0.874 for UFH bleeding). Prehospital administration of ASA and UFH by emergency physicians did not significantly change in-hospital mortality (OR 0.813 for ASA, OR 1.036 for UFH) or bleeding rates (OR 1.142 for ASA, OR 1.053 for UFH) in patients with suspected myocardial infarction.