Acute Ischemic Heart DiseaseCharacterization and clinical course of patients not receiving aspirin for acute myocardial infarction: Results from the MITRA and MIR studies*,**
Section snippets
Methods
The Maximal Individual Ther apy in Acute Myocardial Infarction (MITRA) study and the Myocardial Infarction Registry (MIR) were prospective multicenter registries of the current treatment of ST elevation myocardial infarction in Germany. In MITRA, 8194 patients were recruited from 1994 to 1998 in 54 hospitals ranging from universities to small community hospitals in the southwest of Germany. MIR was a nationwide registry that included 14,378 patients in 217 mainly community hospitals from 1996
Results
Of 22,572 patients included in the MITRA and MIR registries from 1994 to 1998, 1767 (7.8%) did not receive aspirin within the first 48 hours after AMI.
Discussion
We used data of the MITRA and MIR registries, collected between 1994 and 1998, and analyze patient demographics and clinical courses of patients without aspirin for AMI. These registries provide data on a wide range of patients in routine clinical practice all over Germany. Although randomized clinical trials (RCTs) are the best scientific technique for evaluating the effect of therapies in medicine, they do not provide data on current clinical practice. Patients in RCTs are also usually highly
Conclusions
In current clinical practice in Germany, only a minority of patients (7.8%) do not receive aspirin for AMI. Our study revealed two main factors influencing the application of aspirin:
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Patients in critical condition at admission. If these patients survived the early phase of AMI, they were most likely to receive aspirin later during their hospital stay.
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Absolute contraindications account for only a small number of patients without aspirin. Relative contraindications to aspirin such as gastric or
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Cited by (25)
European Resuscitation Council Guidelines 2021: First aid
2021, ResuscitationCitation Excerpt :The 2015 CoSTR recommended the administration of aspirin to adults with chest pain due to suspected myocardial infarction.2,3 This recommendation was based on the evidence from four studies.58–61 A second 2015 CoSTR recommended aspirin administration early (i.e. prehospital or the first few hours after symptom onset) rather than late (at hospital).2,3
European Resuscitation Council Guidelines for Resuscitation 2015 Section 8. Initial management of acute coronary syndromes
2015, ResuscitationCitation Excerpt :Large randomised controlled trials indicate decreased mortality when ASA (75–325 mg) is given to hospitalised patients with ACS independent of the reperfusion or revascularisation strategy. A few studies have suggested reduced mortality if ASA is given earlier.78–80 Therefore, give an oral loading dose of ASA (150 to 300 mg of a non-enteric coated formulation) or 150 mg of an IV preparation as soon as possible to all patients with suspected ACS unless the patient has a known true allergy to ASA or has active bleeding.
European Resuscitation Council Guidelines for Resuscitation 2015. Section 1. Executive summary
2015, ResuscitationCitation Excerpt :In the pre-hospital environment, administer 150-300 mg chewable aspirin early to adults with chest pain due to suspected myocardial infarction (ACS/AMI). There is a relatively low risk of complications particularly anaphylaxis and serious bleeding.836–840 Aspirin should not be administered to patients who have a known allergy or contraindication to aspirin.
European Resuscitation Council Guidelines for Resuscitation 2015 Section 9. First aid
2015, ResuscitationCitation Excerpt :As the plaque contents leak into the artery, platelets clump around them and coronary thrombosis occurs completely or partially occluding the lumen of the artery, leading to myocardial ischemia and possible infarction. The use of aspirin as an antithrombotic agent to potentially reduce mortality and morbidity in ACS/AMI is considered beneficial even when compared with the low risk of complications, particularly anaphylaxis and serious bleeding (requiring transfusion).45–49 The early administration of aspirin in the pre-hospital environment, within the first few hours of the onset of symptoms, also reduces cardiovascular mortality,50,51 supporting the recommendation that first aid providers should administer aspirin to those individuals with chest pain from suspected myocardial infarction.
Part 9: First aid. 2015 International Consensus on First Aid Science with Treatment Recommendations
2015, ResuscitationCitation Excerpt :We also found very-low-quality evidence (downgraded for risk of bias, imprecision, and indirectness) from 1 RCT71 enrolling 100 patients with acute MI showing benefit to aspirin (100 mg, capsule) administration (RR, 0.11; 95% CI, 0.05–0.98). We identified very-low-quality evidence (downgraded for risk of bias and indirectness) from 1 observational study73 with a total of 22 572 patients with acute MI showing no benefit to aspirin (500 mg oral or intravenous loading, 100 mg oral maintenance recommended) administration (RR, 1.05; 95% CI, 0.78–1.42). For the critical outcome of incidence of cardiac arrest, we identified high-quality evidence from 1 RCT70 enrolling 16 981 patients with acute MI showing benefit to aspirin (162.5 mg, enteric-coated) administration (RR, 0.87; 95% CI, 0.79–0.96).
Differences in the management of acute myocardial infarction according to age in the hospitals of Navarre (Spain). The IBERICA study
2005, Revista Espanola de Geriatria y Gerontologia
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Supported in part by Bristol Myers-Squibb, ASTRA-Zeneca, Ministerium für Gesundheit, Arbeit und Soziales des Landes Rheinland-Pfalz, Landesversicherungsanstalt Rheinland-Pfalz, and Barmer und Betriebskrankenkassen Rheinland-Pfalz.
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Reprint requests: Birgit Frilling, Herzzentrum Ludwigshafen, Department of Cardiology, Bremserstr 79, 67063 Ludwigshafen, Germany. E-mail: [email protected]