title: The role of prehospital electrocardiograms in the recognition of ST-segment elevation myocardial infarctions and reperfusion times.
abstract: BACKGROUND
  Clinical outcomes in ST-segment elevation myocardial infarction (STEMI) are related to reperfusion times. Given the benefit of early recognition of STEMI and resulting ability to decrease reperfusion times and improve mortality, current prehospital recommendations are to obtain electrocardiograms (ECGs) in patients with concern for acute coronary syndrome.
  
  
  OBJECTIVE
  We sought to determine the effect of wireless transmission of prehospital ECGs on STEMI recognition and reperfusion times. We hypothesized decreased reperfusion times in patients in whom prehospital ECGs were obtained.
  
  
  METHODS
  We conducted a retrospective, observational study of patients who presented to our suburban, tertiary care, teaching hospital emergency department with STEMI on a prehospital ECG.
  
  
  RESULTS
  Ninety-nine patients underwent reperfusion therapy. Patients with prehospital ECGs had a mean time to angioplasty suite of 43 min (95% confidence interval [CI] 31-54). Compared to patients with no prehospital ECG, mean time to angioplasty suite was 49 min (95% CI 41-57), p = 0.035. Patients with prehospital STEMI identification and catheterization laboratory activation had a mean time to angioplasty suite of 33 min (95% CI 25-41), p = 0.007. Patients with prehospital ECGs had a mean door-to-balloon time of 66 min (95% CI 53-79), whereas the control group had a mean door-to-balloon time of 79 min (95% CI 67-90), p = 0.024. Patients with prehospital STEMI identification and catheterization laboratory activation had a mean door-to-balloon time of 58 min (95% CI 48-68), p = 0.018.
  
  
  CONCLUSIONS
  Prehospital STEMI identification allows for prompt catheterization laboratory activation, leading to decreased reperfusion times.
authors.affiliation: Section of Emergency Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Kerem
authors.affiliation: Department of Emergency Medicine, Mercy Medical Center, Cedar Rapids, Iowa.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Eastvold
authors.affiliation: Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, Illinois.
authors.forename: DeAnn
authors.initials: D
authors.lastname: Faragoi
authors.affiliation: Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, Illinois.
authors.forename: Diana
authors.initials: D
authors.lastname: Strasburger
authors.affiliation: Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, Illinois.
authors.forename: Sean E
authors.initials: SE
authors.lastname: Motzny
authors.affiliation: Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, Illinois.
authors.forename: Erik B
authors.initials: EB
authors.lastname: Kulstad
mesh_terms: D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D016022:Case-Control Studies; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy; D015428:Myocardial Reperfusion Injury / Q000175:diagnosis*; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data*
keywords: ECG; STEMI; acute coronary syndrome; prehospital; reperfusion