Robin A Ducas1, Christopher Labos2, David Allen3, Mehrdad Golian3, Maya Jeyaraman4, Justin Lys4, Amrinder Mann4, Leslie Copstein4, Sherri Vokey5, Rasheda Rabbani4, Ryan Zarychanski6, Ahmed M Abou-Setta7, Alan H Menkis3. 1. University of Manitoba, Winnipeg, Manitoba, Canada; Peter Munk Cardiac Center, University of Toronto, Toronto, Ontario, Canada. Electronic address: robin.ducas@uhn.ca. 2. McGill University, Montreal, Quebec, Canada. 3. University of Manitoba, Winnipeg, Manitoba, Canada. 4. University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada. 5. Neil John Maclean Health Science Library, University of Manitoba, Winnipeg, Manitoba, Canada. 6. University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Haematology and Medical Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada. 7. University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Abstract
BACKGROUND: Delays in reperfusion for patients with myocardial ischemia leads to increased morbidity and mortality. The objective of this review was to identify, evaluate, and critically appraise the evidence on whether pre-hospital electrocardiography (ECG) reduces patient mortality and improves post-ST-segment myocardial infarction patient-oriented outcomes. METHODS: We searched PubMed/MEDLINE, EMBASE, and Cochrane Library (1990-2015) for controlled clinical studies. We also searched conference proceedings, trial registries, and reference lists of narrative and systematic reviews. Two reviewers independently identified and extracted data from studies that compared pre-hospital ECG with standard of care in patients with suspected myocardial infarction who underwent primary percutaneous coronary intervention. Internal validity was assessed using the Newcastle-Ottawa scale. RESULTS: We screened 21,197 citations and included 63 unique studies (plus 22 companion publications). Most studies were of moderate quality. Pre-hospital ECG was associated with significantly fewer deaths (relative risk, 0.68; 95% confidence interval [CI], 0.63-0.74; 45 studies; 71,315 patients; I2, 0%), reduced time to reperfusion (mean difference, -35.32 minutes; 95% CI, -44.02 to -26.61; 26 studies; 27,524 patients; I2, 97%), shorter hospital stays (mean difference, -0.63 days; 95% CI, -1.05 to -0.20; 10 studies; 39,275 patients; I2, 39%), and more patients had first medical contact to device time < 90 minutes than standard of care (relative risk, 1.77; 95% CI, 1.52-2.07; 11 studies; 20,991patients; I2, 93%). CONCLUSIONS: Use of pre-hospital ECG is associated with decreased mortality and overall better patient outcomes. Copyright Â
BACKGROUND: Delays in reperfusion for patients with myocardial ischemia leads to increased morbidity and mortality. The objective of this review was to identify, evaluate, and critically appraise the evidence on whether pre-hospital electrocardiography (ECG) reduces patient mortality and improves post-ST-segment myocardial infarctionpatient-oriented outcomes. METHODS: We searched PubMed/MEDLINE, EMBASE, and Cochrane Library (1990-2015) for controlled clinical studies. We also searched conference proceedings, trial registries, and reference lists of narrative and systematic reviews. Two reviewers independently identified and extracted data from studies that compared pre-hospital ECG with standard of care in patients with suspected myocardial infarction who underwent primary percutaneous coronary intervention. Internal validity was assessed using the Newcastle-Ottawa scale. RESULTS: We screened 21,197 citations and included 63 unique studies (plus 22 companion publications). Most studies were of moderate quality. Pre-hospital ECG was associated with significantly fewer deaths (relative risk, 0.68; 95% confidence interval [CI], 0.63-0.74; 45 studies; 71,315 patients; I2, 0%), reduced time to reperfusion (mean difference, -35.32 minutes; 95% CI, -44.02 to -26.61; 26 studies; 27,524 patients; I2, 97%), shorter hospital stays (mean difference, -0.63 days; 95% CI, -1.05 to -0.20; 10 studies; 39,275 patients; I2, 39%), and more patients had first medical contact to device time < 90 minutes than standard of care (relative risk, 1.77; 95% CI, 1.52-2.07; 11 studies; 20,991patients; I2, 93%). CONCLUSIONS: Use of pre-hospital ECG is associated with decreased mortality and overall better patient outcomes. Copyright Â
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