title: The Emergency Medical Care of Patients With Acute Myocardial Infarction.
abstract: BACKGROUND
  Optimizing the emergency medical care chain might shorten the time to treatment of patients with ST-elevation myocardial infarction (STEMI). The initial care by a physician, and, in particular, correct ECG interpretation, are critically important factors.
  
  
  METHODS
  From 1999 onward, data on the care of patients with myocardial infarction have been recorded and analyzed in the Berlin Myocardial Infarction Registry. In the First Medical Contact Study, data on initial emergency medical care were obtained on 1038 patients who had been initially treated by emergency physicians in 2012. Their pre-hospital ECGs were re-evaluated in a blinded fashion according to the criteria of the European Society of Cardiology.
  
  
  RESULTS
  The retrospective re-evaluation of pre-hospital ECGs revealed that 756 of the 1038 patients had sustained a STEMI. The emergency physicians had correctly diagnosed STEMI in 472 patients (62.4%), and they had correctly diagnosed ventricular fibrillation in 85 patients (11.2%); in 199 patients (26.3%), the ECG interpretation was unclear. The pre-hospital ECG interpretation was significantly associated with the site of initial hospitalization and the ensuing times to treatment. In particular, the time from hospital admission to cardiac catheterization was longer in patients with an unclear initial ECG interpretation than in those with correctly diagnosed STEMI (121 [54; 705] vs. 36 [19; 60] minutes, p <0.001). After multivariate adjustment, this corresponded to a hazard ratio* of 2.67 [2.21; 3.24].
  
  
  CONCLUSIONS
  Pre-hospital ECG interpretation in patients with STEMI was a trigger factor with a major influence on the time to treatment in the hospital. The considerable percentage of pre-hospital ECGs whose interpretation was unclear implies that there is much room for improvement.
authors.affiliation: Medical Clinic I (Department of Cardiology), Havelland Kliniken GmbH, Nauen, Berlin Myocardial Infarction Registry at the Department for Structural Advancement and Quality Manangement in Healthcare at Technische Universität Berlin, Medical Department, Division of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Medical Department, Division of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Department of Cardiology and Intensive Care Medicine, Vivantes Humboldt-Klinikum, Berlin, Department of Internal Medicine, Department of Cardiology, DRK-Kliniken Westend, Berlin, Berliner Feuerwehr, Department of Cardiology, Diabetology, and Intensive Care Medicine, Vivantes Auguste-Viktoria-Klinikum, Berlin.
authors.forename: Martin
authors.initials: M
authors.lastname: Stockburger
authors.forename: Birga
authors.initials: B
authors.lastname: Maier
authors.forename: Georg
authors.initials: G
authors.lastname: Fröhlich
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rutsch
authors.forename: Steffen
authors.initials: S
authors.lastname: Behrens
authors.forename: Ralph
authors.initials: R
authors.lastname: Schoeller
authors.forename: Heinz
authors.initials: H
authors.lastname: Theres
authors.forename: Stefan
authors.initials: S
authors.lastname: Poloczek
authors.forename: Gerd
authors.initials: G
authors.lastname: Plock
authors.forename: Helmut
authors.initials: H
authors.lastname: Schühlen
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control; D004562:Electrocardiography / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome