title: Effects of prehospital 12-lead ECG on processes of care and mortality in acute coronary syndrome: a linked cohort study from the Myocardial Ischaemia National Audit Project.
abstract: OBJECTIVE
  To describe patterns of prehospital ECG (PHECG) use and determine its association with processes and outcomes of care in patients with ST-elevation myocardial infarction (STEMI) and non-STEMI.
  
  
  METHODS
  Population-based linked cohort study of a national myocardial infarction registry.
  
  
  RESULTS
  288 990 patients were admitted to hospitals via emergency medical services (EMS) between 1 January 2005 and 31 December 2009. PHECG use increased overall (51% vs 64%, adjusted OR (aOR) 2.17, 95% CI 2.12 to 2.22), and in STEMI (64% vs 79%, aOR 2.34, 95% CI 2.25 to 2.44). Patients who received PHECG were younger (71 years vs 74 years, P<0.0001); and less likely to be female (33.1% vs 40.3%, OR 0.87, 95% CI 0.86 to 0.89), or to have comorbidities than those who did not. For STEMI, reperfusion was more frequent in those having PHECG (83.5% vs 74.4%, p<0.0001). PHECG was associated with more primary percutaneous coronary intervention patients achieving call-to-balloon time <90 min (27.9% vs 21.4%, aOR 1.38, 95% CI 1.24 to 1.54) and more patients who received fibrinolytic therapy achieving door-to-needle time <30 min (90.6% vs 83.7%, aOR 2.13, 95% CI 1.91 to 2.38). Patients with PHECG exhibited significantly lower 30-day mortality rates than those who did not (7.4% vs 8.2%, aOR 0.94, 95% CI 0.91 to 0.96).
  
  
  CONCLUSIONS
  Findings from this national MI registry demonstrate a survival advantage in STEMI and non-STEMI patients when PHECG was used.
authors.affiliation: Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Quinn
authors.affiliation: Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK Surrey Clinical Research Centre, University of Surrey, Guildford, UK.
authors.forename: Sigurd
authors.initials: S
authors.lastname: Johnsen
authors.affiliation: Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK Department of Cardiology, York Teaching Hospital NHS Foundation Trust, York, UK.
authors.forename: Chris P
authors.initials: CP
authors.lastname: Gale
authors.affiliation: College of Medicine, Swansea University, Swansea, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Snooks
authors.affiliation: NHS Fife, Kirkcaldy, Fife, UK.
authors.forename: Scott
authors.initials: S
authors.lastname: McLean
authors.affiliation: Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Woollard
authors.affiliation: College of Medicine, Swansea University, Swansea, UK.
authors.forename: Clive
authors.initials: C
authors.lastname: Weston
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004562:Electrocardiography / Q000639:trends; D004632:Emergency Medical Services / Q000379:methods* / Q000639:trends; D004636:Emergency Service, Hospital / Q000639:trends; D004739:England; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000639:trends; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D012042:Registries; D012737:Sex Factors; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014852:Wales
keywords: 12 lead ECG; acute coronary syndrome; emergency medicine; pre-hospital care; quality of care and outcomes
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