PMID- 26024432
OWN - NLM
STAT- MEDLINE
DCOM- 20161017
LR  - 20161230
IS  - 1545-0066 (Electronic)
IS  - 1090-3127 (Linking)
VI  - 20
IP  - 1
DP  - 2016
TI  - Prehospital Nitroglycerin Safety in Inferior ST Elevation Myocardial Infarction.
PG  - 76-81
LID - 10.3109/10903127.2015.1037480 [doi]
AB  - Patients with inferior ST elevation myocardial infarction (STEMI), associated 
      with right ventricular infarction, are thought to be at higher risk of developing 
      hypotension when administered nitroglycerin (NTG). However, current basic life 
      support (BLS) protocols do not differentiate location of STEMI prior to NTG 
      administration. We sought to determine if NTG administration is more likely to be 
      associated with hypotension (systolic blood pressure < 90 mmHg) in inferior STEMI 
      compared to non-inferior STEMI. We conducted a retrospective chart review of 
      prehospital patients with chest pain of suspected cardiac origin and 
      computer-interpreted prehospital ECGs indicating "ACUTE MI." We included all 
      local STEMI cases identified as part of our STEMI registry. Univariate analysis 
      was used to compare differences in proportions of hypotension and drop in 
      systolic blood pressure >/= 30 mmHg after nitroglycerin administration between 
      patients with inferior wall STEMI and those with STEMI in another region 
      (non-inferior). Multiple variable logistic regression analysis was also used to 
      assess the study outcomes while controlling for various factors. Over a 29-month 
      period, we identified 1,466 STEMI cases. Of those, 821 (56.0%) received NTG. We 
      excluded 16 cases because of missing data. Hypotension occurred post NTG in 
      38/466 inferior STEMIs and 30/339 non-inferior STEMIs, 8.2% vs. 8.9%, p = 0.73. A 
      drop in systolic blood pressure >/= 30 mmHg post NTG occurred in 23.4% of inferior 
      STEMIs and 23.9% of non-inferior STEMIs, p = 0.87. Interrater agreement for chart 
      review of the primary outcome was excellent (kappa = 0.94). NTG administration to 
      patients with chest pain and inferior STEMI on their computer-interpreted 
      electrocardiogram is not associated with a higher rate of hypotension compared to 
      patients with STEMI in other territories. Computer interpretation of inferior 
      STEMI cannot be used as the sole predictor for patients who may be at higher risk 
      for hypotension following NTG administration.
FAU - Robichaud, Laurie
AU  - Robichaud L
FAU - Ross, Dave
AU  - Ross D
FAU - Proulx, Marie-Helene
AU  - Proulx MH
FAU - Legare, Sebastien
AU  - Legare S
FAU - Vacon, Charlene
AU  - Vacon C
FAU - Xue, Xiaoqing
AU  - Xue X
FAU - Segal, Eli
AU  - Segal E
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150529
PL  - England
TA  - Prehosp Emerg Care
JT  - Prehospital emergency care
JID - 9703530
RN  - 0 (Vasodilator Agents)
RN  - G59M7S0WS3 (Nitroglycerin)
SB  - IM
MH  - Chest Pain
MH  - Electrocardiography
MH  - Emergency Medical Services/*methods
MH  - Female
MH  - Humans
MH  - Hypotension/chemically induced
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*drug therapy
MH  - Nitroglycerin/*therapeutic use
MH  - Quebec
MH  - Registries
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Treatment Outcome
MH  - Vasodilator Agents/*therapeutic use
OTO - NOTNLM
OT  - blood pressure
OT  - emergency medical services
OT  - myocardial infarction
OT  - nitroglycerin
EDAT- 2015/05/30 06:00
MHDA- 2016/10/19 06:00
CRDT- 2015/05/30 06:00
PHST- 2015/05/30 06:00 [entrez]
PHST- 2015/05/30 06:00 [pubmed]
PHST- 2016/10/19 06:00 [medline]
AID - 10.3109/10903127.2015.1037480 [doi]
PST - ppublish
SO  - Prehosp Emerg Care. 2016;20(1):76-81. doi: 10.3109/10903127.2015.1037480. Epub 
      2015 May 29.