Utilization and impact of pre-hospital electrocardiograms for patients with acute ST-segment elevation myocardial infarction: data from the NCDR (National Cardiovascular Data Registry) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry.
OBJECTIVE
This study sought to determine the association of pre-hospital electrocardiograms (ECGs) and the timing of reperfusion therapy for patients with ST-segment elevation myocardial infarction (STEMI).


BACKGROUND
Pre-hospital ECGs have been recommended in the management of patients with chest pain transported by emergency medical services (EMS).


METHODS
We evaluated patients with STEMI from the NCDR (National Cardiovascular Data Registry) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) registry who were transported by EMS from January 1, 2007, through December 31, 2007. Patients were stratified by the use of pre-hospital ECGs, and timing of reperfusion therapy was compared between the 2 groups.


RESULTS
A total of 7,098 of 12,097 patients (58.7%) utilized EMS, and 1,941 of these 7,098 EMS transport patients (27.4%) received a pre-hospital ECG. Among the EMS transport population, primary percutaneous coronary intervention was performed in 92.1% of patients with a pre-hospital ECG versus 86.3% with an in-hospital ECG, whereas fibrinolytic therapy was used in 4.6% versus 4.2% of patients. Median door-to-needle times for patients receiving fibrinolytic therapy (19 min vs. 29 min, p = 0.003) and median door-to-balloon times for patients undergoing primary percutaneous coronary intervention (61 min vs. 75 min, p < 0.0001) were significantly shorter for patients with a pre-hospital ECG. A suggestive trend for a lower risk of in-hospital mortality was observed with pre-hospital ECG use (adjusted odds ratio: 0.80, 95% confidence interval: 0.63 to 1.01).


CONCLUSIONS
Only one-quarter of these patients transported by EMS receive a pre-hospital ECG. The use of a pre-hospital ECG was associated with a greater use of reperfusion therapy, faster reperfusion times, and a suggested trend for a lower risk of mortality.
Diercks
Deborah B
DB
Department of Emergency Medicine, University of California, Davis Medical Center, Sacramento, CA 95661, USA. dbdiercks@ucdavis.edu
Kontos
Michael C
MC
Chen
Anita Y
AY
Pollack
Charles V
CV
Wiviott
Stephen D
SD
Rumsfeld
John S
JS
Magid
David J
DJ
Gibler
W Brian
WB
Cannon
Christopher P
CP
Peterson
Eric D
ED
Roe
Matthew T
MT
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D015425:Myocardial Reperfusion; D012042:Registries; D013997:Time Factors
D005343:Fibrinolytic Agents