OBJECTIVES: This study sought to determine the association of pre-hospital electrocardiograms (ECGs) and the timing of reperfusion therapy for patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Pre-hospital ECGs have been recommended in the management of patients with chest pain transported by emergency medical services (EMS). METHODS: We evaluated patients with STEMI from the NCDR (National Cardiovascular Data Registry) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) registry who were transported by EMS from January 1, 2007, through December 31, 2007. Patients were stratified by the use of pre-hospital ECGs, and timing of reperfusion therapy was compared between the 2 groups. RESULTS: A total of 7,098 of 12,097 patients (58.7%) utilized EMS, and 1,941 of these 7,098 EMS transport patients (27.4%) received a pre-hospital ECG. Among the EMS transport population, primary percutaneous coronary intervention was performed in 92.1% of patients with a pre-hospital ECG versus 86.3% with an in-hospital ECG, whereas fibrinolytic therapy was used in 4.6% versus 4.2% of patients. Median door-to-needle times for patients receiving fibrinolytic therapy (19 min vs. 29 min, p = 0.003) and median door-to-balloon times for patients undergoing primary percutaneous coronary intervention (61 min vs. 75 min, p < 0.0001) were significantly shorter for patients with a pre-hospital ECG. A suggestive trend for a lower risk of in-hospital mortality was observed with pre-hospital ECG use (adjusted odds ratio: 0.80, 95% confidence interval: 0.63 to 1.01). CONCLUSIONS: Only one-quarter of these patients transported by EMS receive a pre-hospital ECG. The use of a pre-hospital ECG was associated with a greater use of reperfusion therapy, faster reperfusion times, and a suggested trend for a lower risk of mortality.
OBJECTIVES: This study sought to determine the association of pre-hospital electrocardiograms (ECGs) and the timing of reperfusion therapy for patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Pre-hospital ECGs have been recommended in the management of patients with chest pain transported by emergency medical services (EMS). METHODS: We evaluated patients with STEMI from the NCDR (National Cardiovascular Data Registry) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) registry who were transported by EMS from January 1, 2007, through December 31, 2007. Patients were stratified by the use of pre-hospital ECGs, and timing of reperfusion therapy was compared between the 2 groups. RESULTS: A total of 7,098 of 12,097 patients (58.7%) utilized EMS, and 1,941 of these 7,098 EMS transport patients (27.4%) received a pre-hospital ECG. Among the EMS transport population, primary percutaneous coronary intervention was performed in 92.1% of patients with a pre-hospital ECG versus 86.3% with an in-hospital ECG, whereas fibrinolytic therapy was used in 4.6% versus 4.2% of patients. Median door-to-needle times for patients receiving fibrinolytic therapy (19 min vs. 29 min, p = 0.003) and median door-to-balloon times for patients undergoing primary percutaneous coronary intervention (61 min vs. 75 min, p < 0.0001) were significantly shorter for patients with a pre-hospital ECG. A suggestive trend for a lower risk of in-hospital mortality was observed with pre-hospital ECG use (adjusted odds ratio: 0.80, 95% confidence interval: 0.63 to 1.01). CONCLUSIONS: Only one-quarter of these patients transported by EMS receive a pre-hospital ECG. The use of a pre-hospital ECG was associated with a greater use of reperfusion therapy, faster reperfusion times, and a suggested trend for a lower risk of mortality.
Authors: Jakob Dörler; Hannes Franz Alber; Johann Altenberger; Gerhard Bonner; Werner Benzer; Georg Grimm; Kurt Huber; Lalit Kaltenbach; Karl-Peter Pfeiffer; Herwig Schuchlenz; Peter Siostrzonek; Gerald Zenker; Otmar Pachinger; Franz Weidinger Journal: Wien Klin Wochenschr Date: 2010-04 Impact factor: 1.704
Authors: Mathew Mercuri; Michelle Welsford; Jon-David Schwalm; Shamir R Mehta; Purnima Rao-Melacini; Tej Sheth; Michael Rokoss; Sanjit S Jolly; James L Velianou; Madhu K Natarajan Journal: CMAJ Open Date: 2015-01-13
Authors: Jessica K Zègre-Hemsey; Josephine Asafu-Adjei; Antonio Fernandez; Jane Brice Journal: Prehosp Emerg Care Date: 2019-04-17 Impact factor: 3.077
Authors: Denise H Daudelin; Assaad J Sayah; Manlik Kwong; Marc C Restuccia; William A Porcaro; Robin Ruthazer; Jessica D Goetz; William M Lane; Joni R Beshansky; Harry P Selker Journal: Circ Cardiovasc Qual Outcomes Date: 2010-05
Authors: Rodrigo Estévez-Loureiro; Angela López-Sainz; Armando Pérez de Prado; Carlos Cuellas; Ramón Calviño Santos; Norberto Alonso-Orcajo; Jorge Salgado Fernández; Jose Manuel Vázquez-Rodríguez; Maria López-Benito; Felipe Fernández-Vázquez Journal: World J Cardiol Date: 2014-06-26