title: Importance and limits of pre-hospital electrocardiogram in patients with ST elevation myocardial infarction undergoing percutaneous coronary angioplasty.
abstract: BACKGROUND
  The purpose of this study is to present data on the effects of pre-hospital electrocardiogram (PH-ECG) on the outcome of ST elevation myocardial infarction (STEMI) patients treated with percutaneous coronary angioplasty (PCI) included in a registry undertaken in the Italian region of Lombardy. Pre-hospital 12-lead electrocardiogram is recommended by current guidelines in order to achieve faster times to reperfusion in patients with STEMI.
  
  
  METHODS
  The registry includes 3901 STEMI patients who underwent primary PCI over an 18-month period.
  
  
  RESULTS
  Mean age was 63 ± 12 years. Admission through the emergency medical system (EMS) occurred in 1603 patients (40%): they were older, more frequently had previous MI, TIMI flow = 0 at entry and were more frequently in Killip class >1 than patients who were not admitted through the EMS. Among the patients admitted through the EMS, PH-ECG was obtained in 475 patients (12%). These patients had less frequently an anterior MI, but more frequently had absence of TIMI flow at entry than patients whose ECG was not teletransmitted. Moreover, they had a significantly shorter first medical contact-to-balloon time and a trend toward a lower 30-day death rate (5.3% vs 7.9 %, p = 0.06). However, only patients in Killip class 2-3 had a significantly lower mortality when the diagnostic ECG was transmitted, whereas no difference was found in Killip class 1 or Killip class 4 patients.
  
  
  CONCLUSIONS
  In this registry, PH-ECG significantly decreased first medical contact-to-balloon time. Attempts to achieve faster reperfusion times should be undertaken, as this may result in improved outcome, particularly in patients with mild to moderate symptoms of heart failure.
authors: Ospedale Fornaroli, Magenta, Italy.
authors: Alessandro
authors: A
authors: Martinoni
authors: Stefano
authors: S
authors: De Servi
authors: Enrico
authors: E
authors: Boschetti
authors: Roberto
authors: R
authors: Zanini
authors: Tullio
authors: T
authors: Palmerini
authors: Alessandro
authors: A
authors: Politi
authors: Giuseppe
authors: G
authors: Musumeci
authors: Guido
authors: G
authors: Belli
authors: Marcella
authors: M
authors: De Paolis
authors: Federica
authors: F
authors: Ettori
authors: Emanuela
authors: E
authors: Piccaluga
authors: Diego
authors: D
authors: Sangiorgi
authors: Alessandra
authors: A
authors: Repetto
authors: Maurizio
authors: M
authors: D'Urbano
authors: Battistina
authors: B
authors: Castiglioni
authors: Franco
authors: F
authors: Fabbiocchi
authors: Marco
authors: M
authors: Onofri
authors: Nicoletta
authors: N
authors: De Cesare
authors: Giuseppe
authors: G
authors: Sangiorgi
authors: Corrado
authors: C
authors: Lettieri
authors: Fabrizio
authors: F
authors: Poletti
authors: Salvatore
authors: S
authors: Pirelli
authors: Silvio
authors: S
authors: Klugmann
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors