Nguyen Dang Thang1, Birgitta Wireklint Sundström2, Thomas Karlsson3, Johan Herlitz4, Björn Wilgot Karlson5. 1. Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: victordangthang@hmu.edu.vn. 2. School of Health Sciences, Research Centre PreHospen, University of Borås, The Prehospital Research Centre of Western Sweden, Sweden. 3. Centre for Applied Biostatistics, Occupational and Environmental Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. 4. Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; School of Health Sciences, Research Centre PreHospen, University of Borås, The Prehospital Research Centre of Western Sweden, Sweden. 5. Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; AstraZeneca R&D, Mölndal, Sweden.
Abstract
AIMS: The aims of this study were (a) to determine the prehospital prevalence of electrocardiographic (ECG) signs of acute myocardial ischemia in patients with suspected acute coronary syndrome and (b) to describe the relationships between the various ECG patterns and the diagnosis of acute myocardial infarction (AMI) and outcomes. METHODS: Prospective cohort study using data from an interventional trial in acute chest pain patients transported by the emergency medical services. These patients were classified into 3 groups: patients with ECG showing signs of acute myocardial ischemia, patients with ECG showing other abnormal changes (bundle-branch block, pacemaker rhythm, Q-wave or T-wave inversion) and patients without significant pathologic findings. All P values are age-adjusted. RESULTS: Among 1546 patients, 312 (20%) had ECG signs of acute myocardial ischemia. Of them, 57% had a final diagnosis of AMI versus 26% of those with other abnormal ECGs and 12% of those with ECG without significant pathologic findings (P<.0001). In all, 53% of all AMI cases involved patients without ECG signs of acute myocardial ischemia. Although ECG signs of acute myocardial ischemia predicted heart failure and ventricular tachyarrhythmias both prior to and after hospital admission, there was no significant difference in 30-day mortality between the 3 patient groups (4.3%, 3.7%, and 1.2%, respectively, P=.11). CONCLUSION: Among patients with a clinical suspicion of AMI in the prehospital setting, the prevalence of ECG signs suggesting AMI was low, as was the ability to identify AMI patients using ECG findings only. We therefore need better instruments in the prehospital triage of patients with acute chest pain.
AIMS: The aims of this study were (a) to determine the prehospital prevalence of electrocardiographic (ECG) signs of acute myocardial ischemia in patients with suspected acute coronary syndrome and (b) to describe the relationships between the various ECG patterns and the diagnosis of acute myocardial infarction (AMI) and outcomes. METHODS: Prospective cohort study using data from an interventional trial in acute chest painpatients transported by the emergency medical services. These patients were classified into 3 groups: patients with ECG showing signs of acute myocardial ischemia, patients with ECG showing other abnormal changes (bundle-branch block, pacemaker rhythm, Q-wave or T-wave inversion) and patients without significant pathologic findings. All P values are age-adjusted. RESULTS: Among 1546 patients, 312 (20%) had ECG signs of acute myocardial ischemia. Of them, 57% had a final diagnosis of AMI versus 26% of those with other abnormal ECGs and 12% of those with ECG without significant pathologic findings (P<.0001). In all, 53% of all AMI cases involved patients without ECG signs of acute myocardial ischemia. Although ECG signs of acute myocardial ischemia predicted heart failure and ventricular tachyarrhythmias both prior to and after hospital admission, there was no significant difference in 30-day mortality between the 3 patient groups (4.3%, 3.7%, and 1.2%, respectively, P=.11). CONCLUSION: Among patients with a clinical suspicion of AMI in the prehospital setting, the prevalence of ECG signs suggesting AMI was low, as was the ability to identify AMI patients using ECG findings only. We therefore need better instruments in the prehospital triage of patients with acute chest pain.
Authors: Salah S Al-Zaiti; Ziad Faramand; Mohammad O Alrawashdeh; Susan M Sereika; Christian Martin-Gill; Clifton Callaway Journal: Am J Emerg Med Date: 2018-06-08 Impact factor: 2.469
Authors: Jason P Stopyra; Anna C Snavely; Nicklaus P Ashburn; James O'Neill; Brennan E Paradee; Brian Hehl; Jordan Vorrie; Matthew Wells; R Darrell Nelson; Nella W Hendley; Chadwick D Miller; Simon A Mahler Journal: Prehosp Emerg Care Date: 2022-02-17 Impact factor: 2.686