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Heart. 2014 Jun;100(12):944-50. doi: 10.1136/heartjnl-2013-304599. Epub 2014 Apr 14.

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.

Author information

1
Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
2
Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK Surrey Clinical Research Centre, University of Surrey, Guildford, UK.
3
Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK Department of Cardiology, York Teaching Hospital NHS Foundation Trust, York, UK.
4
College of Medicine, Swansea University, Swansea, UK.
5
NHS Fife, Kirkcaldy, Fife, UK.

Abstract

OBJECTIVE:

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 <90 min (27.9% vs 21.4%, aOR 1.38, 95% CI 1.24 to 1.54) and more patients who received fibrinolytic therapy achieving door-to-needle time <30 min (90.6% vs 83.7%, aOR 2.13, 95% CI 1.91 to 2.38). Patients with PHECG exhibited significantly lower 30-day mortality rates than those who did not (7.4% vs 8.2%, aOR 0.94, 95% CI 0.91 to 0.96).

CONCLUSIONS:

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

KEYWORDS:

12 lead ECG; acute coronary syndrome; emergency medicine; pre-hospital care; quality of care and outcomes

PMID:
24732676
PMCID:
PMC4033209
DOI:
10.1136/heartjnl-2013-304599
[Indexed for MEDLINE]
Free PMC Article

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