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Determinants of pre-hospital pharmacological intervention and its association with outcome in acute myocardial infarction
Sahlgrenska University Hospital.
Sahlgrenska University Hospital ; University of Borås.
University of Borås.
Karolinska Institutet.
Show others and affiliations
2015 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 23, no 105Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2015. Vol. 23, no 105
Keyword [en]
Chest pain, Myocardial infarction, Emergency medical services, Early medical intervention, Aspirin, Nitroglycerin
National Category
Medical and Health Sciences
Research subject
Natural Science, Medicine
Identifiers
URN: urn:nbn:se:lnu:diva-62758DOI: 10.1186/s13049-015-0188-xOAI: oai:DiVA.org:lnu-62758DiVA: diva2:1092611
Available from: 2017-05-03 Created: 2017-05-03 Last updated: 2017-09-22Bibliographically approved

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CiteExportLink to record
Permanent link

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Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
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  • text
  • asciidoc
  • rtf