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Use of prehospital ECGs reduces time to reperfusion, findings show

Thursday, April 03 2008 | Comments

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What's This? By Courtneay Parsons

Prehospital electrocardiograms reduce reperfusion times in patients with suspected ST-elevation myocardial infarction (STEMI) who are first evaluated by emergency medical services (EMS) personnel outside the hospital setting, data suggest.

The study authors noted that the current American Heart Association/American College of Cardiology guidelines and the nationwide Door-to-Balloon (D2B) Initiative encourage the use of prehospital ECGs to speed identification of patients with STEMI by EMS personnel.

In the current investigation, researchers sought to evaluate the current use of prehospital ECGs in the triage of patients with STEMI and the impact of their use on reperfusion times. They reviewed the national ACTION registry database and identified patients with STEMI who presented to an ACTION hospital within 24 hours of ischemic symptom onset and were found to have persistent ST-elevation on ECG or new left bundle branch block. After excluding patients without reperfusion data and/or clear ECG data, 4,138 individuals remained for analysis.

The reperfusion strategy was primary percutaneous coronary intervention in 94.4% of the patients and fibrinolytic therapy in 5.6%. The authors noted that prehospital ECGs were performed in only 17.6% of the entire population and in only 29% of the subgroup that presented via EMS.

In an analysis restricted to the 2,417 patients admitted by EMS, median door-to-needle and door-to-reperfusion times were significantly shorter among patients who received prehospital ECGs relative to those who did not receive them (door-to-needle times, 18 min vs 26 min; P=.02; door-to-reperfusion times, 62 min vs 77 min; P<.001).

These differences remained in adjusted analyses of patients who presented via EMS (31.5 min reduction in door-to-needle time and 16.58 min reduction in door-to-reperfusion time) and in adjusted analyses of the entire study population (21.6 minutes and 21.85 min, respectively).

Dr. Deborah Diercks, lead investigator of the study and an associate professor of emergency medicine at the University of California, Davis Medical Center, told VerusMed that prehospital ECGs are an integral part of the ACC and AHA's systematic approach to STEMI receiving centers.

She added that this analysis should support the push for prehospital ECGs and should help EMS systems get the funding they need to implement them as a triage tool. (Poster 1017-86.)

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