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Prehospital Administration of Aspirin and Nitroglycerin for Patients With Suspected Acute Coronary Syndrome ― A Systematic Review ―
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- Nakayama Naoki
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center
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- Yamamoto Takeshi
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
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- Kikuchi Migaku
- Department of Cardiovascular Medicine, Emergency and Critical Care Center, Dokkyo Medical University
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- Hanada Hiroyuki
- Department of Emergency and Disaster Medicine, Hirosaki University
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- Mano Toshiaki
- Kansai Rosai Hospital Cardiovascular Center
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- Nakashima Takahiro
- Department of Emergency Medicine and Michigan Center for Integrative Research in Critical Care, University of Michigan
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- Hashiba Katsutaka
- Department of Cardiology, Saiseikai Yokohama-shi Nanbu Hospital
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- Tanaka Akihito
- Department of Cardiology, Nagoya University Graduate School of Medicine
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- Matsuo Kunihiro
- Department of Acute Care Medicine, Fukuoka University Chikushi Hospital
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- Nomura Osamu
- Department of Emergency and Disaster Medicine, Hirosaki University
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- Kojima Sunao
- Department of Internal Medicine, Sakurajyuji Yatsushiro Rehabilitation Hospital
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- Yamaguchi Junichi
- Department of Cardiology, Tokyo Women’s Medical University
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- Matoba Tetsuya
- Department of Cardiovascular Medicine, Kyushu University Faculty of Medical Sciences
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- Tahara Yoshio
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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- Nonogi Hiroshi
- Faculty of Health Science, Osaka Aoyama University
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Description
<p>Background: Recent guidelines for acute coronary syndrome (ACS) recommend prehospital administration of aspirin and nitroglycerin for ACS patients. However, there is no clear evidence to support this. We investigated the benefits and harms of prehospital administration of aspirin and nitroglycerin by non-physician healthcare professionals in patients with suspected ACS.</p><p>Methods and Results: We searched the PubMed database and used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence. Three retrospective studies for aspirin and 1 for nitroglycerin administered in the prehospital setting to patients with acute myocardial infarction were included. 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. 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). The certainty of evidence was very low in both systematic reviews.</p><p>Conclusions: Our systematic reviews suggest that prehospital administration of aspirin and nitroglycerin by non-physician healthcare professionals is beneficial for patients with suspected ACS, although the certainty of evidence is very low. Further investigation is needed to determine the benefit of the prehospital administration of these agents.</p>
Journal
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- Circulation Reports
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Circulation Reports 4 (10), 449-457, 2022-10-07
The Japanese Circulation Society
