title: The pre-hospital electrocardiogram and time to reperfusion in patients with acute myocardial infarction, 2000-2002: findings from the National Registry of Myocardial Infarction-4.
abstract: OBJECTIVE
  The aim of this study was to determine the use of pre-hospital electrocardiogram (ECG) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing reperfusion therapy, and evaluate the effect of pre-hospital ECG on door-to-reperfusion times.
  
  
  BACKGROUND
  Although national guidelines recommend the use of pre-hospital ECG, there is limited contemporary information about its current use and effectiveness.
  
  
  METHODS
  Using data from the National Registry of Myocardial Infarction-4, we studied patients with STEMI or left bundle branch block who received acute reperfusion with either fibrinolytic therapy (n = 35,370) or primary percutaneous coronary intervention (PCI) (n = 21,277) within 6 h of admission. We determined the prevalence of pre-hospital ECG use, evaluated the association between pre-hospital ECG and door-to-reperfusion time, and estimated the incremental reduction in time to reperfusion using hierarchical models to adjust for differences in patient and hospital characteristics.
  
  
  RESULTS
  A pre-hospital ECG was performed in 4.5% of the fibrinolytic therapy cohort and in 8.0% of the PCI cohort. After adjusting for patient and hospital characteristics, the use of pre-hospital ECG was associated with a significantly shorter geometric mean door-to-drug time: 24.6 min (95% confidence interval [CI]: 23.7 to 25.5) vs. 34.7 min (95% CI: 34.2 to 35.3; p < 0.0001), and a significantly shorter geometric mean door-to-balloon time (94.0 min [95% CI: 91.8 to 96.3] vs. 110.3 min [95% CI: 108.7 to 112.0]; p < 0.0001).
  
  
  CONCLUSIONS
  The national use of pre-hospital ECG to diagnose and facilitate the treatment of STEMI remains low. When used, however, pre-hospital ECG is associated with a significantly shorter time to reperfusion.
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8088, USA.
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.forename: Edward L
authors.initials: EL
authors.lastname: Portnay
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: Robert L
authors.initials: RL
authors.lastname: McNamara
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.forename: Martha E
authors.initials: ME
authors.lastname: Blaney
authors.forename: John G
authors.initials: JG
authors.lastname: Canto
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods; D012042:Registries; D015912:Thrombolytic Therapy; D013997:Time Factors