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Detection of STEMI Using Prehospital Serial 12-Lead Electrocardiograms

Alain Tanguay, Johann Lebon, Lorraine Lau

    Prehospital Emergency Care
    |January 17, 2018
    PubMed

    Insights

    Serial 12-lead electrocardiograms (ECGs) in ambulances helped identify ST-elevation myocardial infarction (STEMI) in 8% of patients initially showing no STEMI. This prehospital ECG monitoring improves STEMI detection during emergency medical services transport.

    Area of Science:

    • Cardiology
    • Emergency Medicine
    • Medical Technology

    Background:

    • Serial 12-lead electrocardiograms (ECGs) may enhance the management of ST-segment elevation (STE) or evolving ST-segment elevation myocardial infarction (STEMI) in prehospital settings.
    • Limited scientific evidence currently supports the clinical utility of serial prehospital ECGs for STEMI detection.

    Purpose of the Study:

    • To evaluate the effectiveness of serial 12-lead ECGs in detecting STEMI among patients during transport by emergency medical services (EMS) in Canada.

    Main Methods:

    • A retrospective study analyzed suspected STEMI patients transported by EMS in Québec, Canada (August 2006 - December 2013).
    • Patients underwent serial 12-lead ECG monitoring with transmission every 2 minutes.
    • ECGs were reviewed by emergency physicians and categorized by persistent or dynamic STE.

    Main Results:

    • Of 728 eligible patients, 84.3% had persistent STE, and 15.7% had dynamic STE.
    • Dynamic STE involved 1 ST-segment change in 11.1% and ≥2 changes in 4.5% of patients.
    • STEMI was identified on a subsequent ECG in 8.0% of cases initially showing no STEMI.

    Conclusions:

    • Prehospital serial 12-lead ECGs identified STEMI in 8% of patients with an initial non-STEMI ECG by recognizing transient ST-segment changes during transport.
    • This method demonstrates value in improving STEMI detection within emergency medical services.
    Abstract

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