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Summary

• Cohort study of national myocardial infarction registry.
• 288,990 patients presented via EMS
  • 145,247 had prehospital ECGs performed (50.3%)
    • 54,953 had a STEMI diagnosis (37.8%)
    • 47,878 had a NSTEMI diagnosis (33.0%)
    • 42,416 had an unknown diagnosis (29.2%)
  • Time from EMS call to arrival at hospital was 6 min longer in patients who had prehospital ECG performed
  • Time from EMS arrival at scene to hospital arrival was 5 min longer in patients who had prehospital ECG performed
  • The use of any reperfusion strategy (PCI or fibrinolytic) in STEMI patients was more frequent in those who had prehospital ECG performed
  • Performance of prehospital ECG was predictive of reperfusion therapy in STEMI
  • Door-to-balloon time for patients who received PPCI for STEMI was not influenced by prehospital ECG
  • Door-to-needle time was influenced by prehospital ECG, with a higher proportion of patients receiving fibrinolytic treatment within 30 min of arrival
  • Patients who received a prehospital ECG exhibited significantly lower hospital and 30-day mortality rates than those who did not.

Limitations

• Observational study, cannot display temporal relationship (cause-effect)
• Findings were dependent on data entered into MINAP database
• Those who died prior to hospital arrival or in the ED (i.e. the most ill) may not have had all data entered into database due to difficulty obtaining and entering it
• No data collected on presenting symptoms, unable to determine indications for prehospital ECG
• Unable to differentiate ECGs which were sent by telemetry and interpreted by cardiology staff versus ECGs interpreted by Paramedics and prehospital staff.
• Unable to determine skill level of those performing and interpreting ECGs – Paramedics and Technicians.
• Male v female bias? Predominantly male prehospital workforce may have been hesitant to perform ECGs on female patients.
• Prehospital ECG did not include ECGs performed by other healthcare professionals prior to ambulance arrival.

 

Quinn T1, Johnsen S, Gale CP, Snooks H, McLean S, Woollard M, Weston C; On behalf of the Myocardial Ischaemia National Audit Project (MINAP) Steering Group. Effects of prehospital 12-lead ECG on processes of care and mortality in acute coronary syndrome: a linked cohort study from the Myocardial Ischaemia National Audit Project. Heart. 2014 Apr 14. PMID: 24732676. To describe patterns of prehospital ECG (PHECG) use and determine its association with processes and outcomes of care in patients with ST-elevation myocardial infarction (STEMI) and non-STEMI. [...]

Abstract

Objectives

To describe patterns of prehospital ECG (PHECG) use and determine its association with processes and outcomes of care in patients with ST-elevation myocardial infarction (STEMI) and non-STEMI.

Methods

Population-based linked cohort study of a national myocardial infarction registry.

Results

288 990 patients were admitted to hospitals via emergency medical services (EMS) between 1 January 2005 and 31 December 2009. PHECG use increased overall (51% vs 64%, adjusted OR (aOR) 2.17, 95% CI 2.12 to 2.22), and in STEMI (64% vs 79%, aOR 2.34, 95% CI 2.25 to 2.44). Patients who received PHECG were younger (71 years vs 74 years, P<0.0001); and less likely to be female (33.1% vs 40.3%, OR 0.87, 95% CI 0.86 to 0.89), or to have comorbidities than those who did not. For STEMI, reperfusion was more frequent in those having PHECG (83.5% vs 74.4%, p<0.0001). PHECG was associated with more primary percutaneous coronary intervention patients achieving call-to-balloon time

Conclusions

Findings from this national MI registry demonstrate a survival advantage in STEMI and non-STEMI patients when PHECG was used.