Prehospital Administration of Aspirin and Nitroglycerin for Patients With Suspected Acute Coronary Syndrome - A Systematic Review.
Prehospital Administration of Aspirin and Nitroglycerin for Patients With Suspected Acute Coronary Syndrome - A Systematic Review.
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DOI：
10.1253/circrep.cr-22-0060
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发表时间：
2022-10-07
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背景：最近的急性冠状动脉综合征（ACS）指南建议ACS患者院前给予阿司匹林和硝酸甘油。然而，没有明确的证据支持这一点。我们调查了院前给予阿司匹林和硝酸甘油的好处和危害，由非医生的医疗保健专业人员在疑似ACS患者。方法 和 结果：我们检索了PubMed数据库，并使用推荐、评估、开发和评价分级（GRADE）方法来评估证据的确定性。纳入了3项关于院前环境中急性心肌梗死患者服用阿司匹林和1项关于硝酸甘油的回顾性研究。与到达医院后服用阿司匹林相比，院前服用阿司匹林与30天和1年死亡率显著降低相关，比值比（OR）分别为0.59（95%置信区间[CI] 0.35-0.99）和0.47（95% CI 0.36-0.62）。与未进行院前给药相比，院前硝酸甘油给药还显著降低了30天和1年死亡率（OR分别为0.34 [95% CI 0.24-0.50]和0.38 [95% CI 0.29-0.50]）。两项系统性综述的证据确定性都很低。结论：我们的系统评价表明，院前非医生的医疗保健专业人员给予阿司匹林和硝酸甘油对疑似ACS患者有益，尽管证据的确定性非常低。需要进一步的调查，以确定这些药物的院前管理的好处。
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. 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. 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.