title: Association of Pre-hospital ECG Administration With Clinical Outcomes in ST-Segment Myocardial Infarction: A Systematic Review and Meta-analysis.
abstract: Delays in reperfusion for patients with myocardial ischemia leads to increased morbidity and mortality. The objective of this review was to identify, evaluate, and critically appraise the evidence on whether pre-hospital electrocardiography (ECG) reduces patient mortality and improves post-ST-segment myocardial infarction patient-oriented outcomes.
  
  
  
  We searched PubMed/MEDLINE, EMBASE, and Cochrane Library (1990-2015) for controlled clinical studies. We also searched conference proceedings, trial registries, and reference lists of narrative and systematic reviews. Two reviewers independently identified and extracted data from studies that compared pre-hospital ECG with standard of care in patients with suspected myocardial infarction who underwent primary percutaneous coronary intervention. Internal validity was assessed using the Newcastle-Ottawa scale.
  
  
  
  We screened 21,197 citations and included 63 unique studies (plus 22 companion publications). Most studies were of moderate quality. Pre-hospital ECG was associated with significantly fewer deaths (relative risk, 0.68; 95% confidence interval [CI], 0.63-0.74; 45 studies; 71,315 patients; I2, 0%), reduced time to reperfusion (mean difference, -35.32 minutes; 95% CI, -44.02 to -26.61; 26 studies; 27,524 patients; I2, 97%), shorter hospital stays (mean difference, -0.63 days; 95% CI, -1.05 to -0.20; 10 studies; 39,275 patients; I2, 39%), and more patients had first medical contact to device time < 90 minutes than standard of care (relative risk, 1.77; 95% CI, 1.52-2.07; 11 studies; 20,991patients; I2, 93%).
  
  
  
  Use of pre-hospital ECG is associated with decreased mortality and overall better patient outcomes.
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada; Peter Munk Cardiac Center, University of Toronto, Toronto, Ontario, Canada. Electronic address: robin.ducas@uhn.ca.
authors.forename: Robin A
authors.initials: RA
authors.lastname: Ducas
authors.affiliation: McGill University, Montreal, Quebec, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Labos
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Allen
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Golian
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Maya
authors.initials: M
authors.lastname: Jeyaraman
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Justin
authors.initials: J
authors.lastname: Lys
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Amrinder
authors.initials: A
authors.lastname: Mann
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Leslie
authors.initials: L
authors.lastname: Copstein
authors.affiliation: Neil John Maclean Health Science Library, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Sherri
authors.initials: S
authors.lastname: Vokey
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Rasheda
authors.initials: R
authors.lastname: Rabbani
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Haematology and Medical Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Ryan
authors.initials: R
authors.lastname: Zarychanski
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Abou-Setta
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Menkis
mesh_terms: D004562:Electrocardiography / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D063868:Patient Outcome Assessment; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D061665:Time-to-Treatment