title: Impact of pre-hospital electrocardiograms on time to treatment and one year outcome in a rural regional ST-segment elevation myocardial infarction network.
abstract: BACKGROUND
  Pre-hospital electrocardiograms (ECGs) are believed to reduce time to reperfusion in ST Segment Elevation Myocardial Infarction (STEMI) patients. Little is known of their impact on clinical outcomes in a rural setting. Geisinger regional STEMI network provides percutaneous coronary intervention (PCI) care to over a 100-mile radius in rural central Pennsylvania.
  
  
  METHODS
  A retrospective analysis identified 280 consecutive STEMI patients treated with PCI between 1/1/09 and 8/31/11. Comparison between two STEMI groups was performed: 205 patients who were taken by the emergency medical system (EMS) to the nearest hospital (a non-PCI center), underwent an ECG revealing a STEMI, and were transported immediately to Geisinger Medical Center (GMC) for PCI (transfer group) versus 75 patients in whom a pre-hospital ECG was obtained and who were transported by EMS directly to Geisinger for PCI, bypassing the nearest hospital that did not perform PCI (the pre-hospital ECG group).
  
  
  RESULTS
  Analysis of baseline characteristics revealed that the pre-hospital ECG cohort was older (65 vs. 60 years); had a higher percentage of previous myocardial infarctions (MI) (28% vs. 15%), heart failure (11% vs. 4%), and prior PCI (23% vs. 13%; p < 0.05 all comparisons). Median time from EMS contact to pre-hospital ECG in the pre-hospital ECG group was 5 minutes; from pre-hospital ECG to the GMC ED was 34 minutes. Median time from first medical contact (EMS contact) to reperfusion (device activation) was 79 versus 157 minutes (P < 0.001), respectively in pre-hospital ECG vs. transfer groups. Mortality in the two groups at 1 year was 4.1% in the pre-hospital ECG group versus 8.3% in the transfer group (P-value = 0.34). After adjusting for the difference in age between the two groups, the 62% reduction in 1 year mortality associated with having obtained a pre-hospital ECG was still not statistically significant (P-value = 0.19).
  
  
  CONCLUSIONS
  In a rural regional STEMI network, pre-hospital ECGs decreased time from first medical contact to reperfusion by 50% and were associated with an excellent clinical outcome at 1 year. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Talwinder S
authors.initials: TS
authors.lastname: Kahlon
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Kulpreet
authors.initials: K
authors.lastname: Barn
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Mian Muhammad Ali
authors.initials: MM
authors.lastname: Akram
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: James C
authors.initials: JC
authors.lastname: Blankenship
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Cinde
authors.initials: C
authors.lastname: Bower-Stout
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Dave J
authors.initials: DJ
authors.lastname: Carey
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Sun
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Karen
authors.initials: K
authors.lastname: Tompkins Weber
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Skelding
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Scott
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Sandy M
authors.initials: SM
authors.lastname: Green
authors.affiliation: North Shore LIJ Health Care System, Great Neck, New York.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
mesh_terms: D000368:Aged; D000552:Ambulances; D002391:Catchment Area, Health; D016009:Chi-Square Distribution; D019033:Delivery of Health Care, Integrated; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010414:Pennsylvania; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D019035:Rural Health Services; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: EMS; PCI; ST segment elevation myocardial infarction; STEMI; emergency medical system; percutaneous coronary intervention