Abstract
Chest pain is a common symptom of acute coronary syndrome, including myocardial infarction (MI). Treatment with antiplatelet agents, such as aspirin, improves survival, although the ideal dose is uncertain. It is unknown if outcomes can be improved by giving aspirin early in the course of MI as part of the first-aid management as opposed to late or in-hospital administration.We searched the Medline, Embase, and Cochrane databases and used Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) for determining the certainty of evidence. We included studies in adults with non-traumatic chest pain, where aspirin was administered early (within two hours) following the onset of chest pain as part of first-aid management as compared with late or in-hospital administration (The International Prospective Register of Systematic Reviews (PROSPERO) registration number: CDR153316). From 1470 references, we included three studies (one randomized controlled trial (RCT) and two non-RCTs). Early administration (median 1.6 hours or pre-hospital) was associated with increased survival as compared with late administration (median 3.5 hours or in-hospital) at seven days; risk ratio (RR) 1.04 (95% CI 1.03-1.06), 30 days RR 1.05 (95% 1.02-1.07), and one-year RR 1.06 (95% CI1.03-1.10). The evidence is of very low certainty due to limitations in study design and the imprecision of the evidence.This systematic review would suggest that the early or first-aid administration of aspirin to adults with non-traumatic chest pain improves survival as compared with late or in-hospital administration.
Highlights
BackgroundChest pain, which in adults is a common symptom of myocardial infarction (MI), results in more than eight million visits to emergency departments (EDs) each year in the US [1]
In 2015, the International Liaison Committee on Resuscitation (ILCOR) published a Consensus on Science and Treatment Recommendation (CoSTR), establishing the role of oral aspirin compared with placebo [5,6]
We identified 1470 references through database searching
Summary
Chest pain, which in adults is a common symptom of myocardial infarction (MI), results in more than eight million visits to emergency departments (EDs) each year in the US [1]. The administration of oral antiplatelet agents, such as aspirin, to individuals with non-traumatic chest pain has been shown to improve survival and is increasingly employed for chest pain in emergency care [3,4]. The ILCOR First Aid Task Force performed a systematic review to investigate the timing of aspirin administration for non-traumatic chest pain. This systematic review was designed to answer the question: Among adults with non-traumatic chest pain, does early or first aid administration of aspirin compared to late or in-hospital administration of aspirin change outcomes of survival, complications, incidence of cardiac arrest, cardiac functional outcome, infarction size, or resolution of chest pain?
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