Journal Article

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

Johnsen, Sigurd, Weston, Clive, Quinn, Tom, Gale, Chris P, Snooks, Helen, McLean, Scott, Woollard, Malcolm

2014

Overview

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.

• Publisher: BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Acute Coronary Syndrome - diagnosis / Acute Coronary Syndrome - mortality / Acute Coronary Syndrome - therapy / Acute coronary syndromes / Age Factors / Aged / Aged, 80 and over / Comorbidity / Coronary Artery Disease / Electrocardiography - trends / Emergency Medical Services - methods / Emergency Medical Services - trends / Emergency Service, Hospital - trends / England / Female / Heart attacks / Heart failure / Humans / Laboratories / Logistic Models / Logistics / Male / Medical Audit / Middle Aged / Mortality / Myocardial Infarction - diagnosis / Myocardial Infarction - mortality / Myocardial Infarction - therapy / Odds Ratio / Outcome and Process Assessment, Health Care - trends / Patients / Percutaneous Coronary Intervention / Predictive Value of Tests / Registries / Sex Factors / Studies / Thrombolytic Therapy / Time Factors / Time-to-Treatment / Treatment Outcome / Variables / Wales