title: Prehospital ECG signs of acute coronary occlusion are associated with reduced one-year mortality.
abstract: BACKGROUND
  We wanted to evaluate predictors of direct admittance to a coronary care unit (CCU) and predictors of death in patients with suspected acute coronary syndromes (ACS).
  
  
  METHODS
  During 2004-2007, all consecutive prehospitally triaged patients with suspected ACS were prospectively included. Prehospital and emergency data were collected at point of care. Data from medical records, ECG-, echocardiography- and laboratory databases was collected retrospectively.
  
  
  RESULTS
  In all, 2757 patients were included. Out of these 858 were directly admitted to the CCU or cath/lab. Predictors for direct admittance to the CCU were ST-segment elevation on the initial ECG; odds ratio (OR) 46.11, left bundle branch block; OR 3.30, ongoing symptoms; OR 2.90, current smoking; OR 2.18 and ST-segment depression; OR 2.05. Independent predictors for 1-year mortality were cardiogenic shock; OR 14.40, increasing age OR (per year) 1.08, diabetes; OR 2.09 and chronic heart failure; OR 1.67. ST-segment elevation was associated with a lower 1-year mortality rate; OR 0.52.
  
  
  CONCLUSIONS
  Among patients with a suspected ACS, prehospital ECG-signs indicating an acute coronary occlusion were not only a predictor for direct admission to acute coronary care but also a predictor for increased survival. To improve future outcome in acute ischemic heart diseases we must find and treat not only the STEMI's but also the high-risk NSTEMIs that otherwise would have a poor prognosis.
authors.affiliation: Institution of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Göteborg, Sweden. Electronic address: annica.ravn-fischer@vgregion.se.
authors.forename: Annica
authors.initials: A
authors.lastname: Ravn-Fischer
authors.forename: Thomas
authors.initials: T
authors.lastname: Karlsson
authors.forename: Per
authors.initials: P
authors.lastname: Johanson
authors.forename: Johan
authors.initials: J
authors.lastname: Herlitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D054059:Coronary Occlusion / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D004562:Electrocardiography / Q000401:mortality* / Q000639:trends; D004632:Emergency Medical Services / Q000379:methods* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014218:Triage / Q000379:methods* / Q000639:trends
keywords: Acute coronary syndrome; Coronary care unit; Mortality; Prehospital triage