Evidence supporting the use of: Acetylsalicylic acid
For the health condition: Chest Pain

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Synopsis

Source of validity: Scientific
Rating (out of 5): 5

Acetylsalicylic acid (ASA), commonly known as aspirin, is scientifically validated in the management of chest pain, especially when the chest pain is suspected to be due to acute coronary syndrome (ACS), including myocardial infarction (heart attack).

Aspirin works by irreversibly inhibiting the cyclooxygenase-1 (COX-1) enzyme, which results in decreased synthesis of thromboxane A2, a molecule that promotes platelet aggregation. By reducing platelet aggregation, aspirin lowers the risk of clot formation in the arteries supplying the heart. This mechanism is critical in the context of ACS, where clot formation can obstruct coronary blood flow, causing or worsening heart attacks.

The clinical efficacy of aspirin in this setting is supported by robust randomized controlled trials and meta-analyses. For example, the ISIS-2 trial (Lancet, 1988) demonstrated that aspirin use in the setting of suspected myocardial infarction significantly reduced vascular mortality. Subsequent guidelines from major cardiology societies (such as the American Heart Association and the European Society of Cardiology) recommend immediate administration of aspirin at the onset of suspected ACS, unless contraindicated.

Thus, the use of acetylsalicylic acid in chest pain due to suspected cardiac origin is not only scientifically validated but also considered a first-line, life-saving intervention. There is no significant evidence supporting its use for non-cardiac chest pain.

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