Catheterization laboratory activations and time intervals for patients with pre-hospital ECGs
Josephine Muhrbeck1, Jonas Persson1, Claes Hofman-Bang1
1a Department of Clinical Sciences, Division of Cardiovascular Medicine , Karolinska Institutet, Danderyd University Hospital , Stockholm , Sweden.
Insights
Pre-hospital ECGs (PH-ECG) enable rapid diagnosis of ST-segment elevation myocardial infarction (STEMI), with a low false-positive activation rate. Most STEMI patients achieved reperfusion therapy within 60 minutes, highlighting the effectiveness of PH-ECG in time-critical cardiac care.
Area of Science:
- Cardiology
- Emergency Medicine
- Medical Technology
Background:
- Pre-hospital ECGs (PH-ECG) are crucial for timely diagnosis and treatment of ST-segment elevation myocardial infarction (STEMI).
- Current guidelines recommend PCI within 90 minutes, but feasibility of a 60-minute target is under investigation for 24/7 PCI-capable hospitals.
Purpose of the Study:
- To determine the proportion of false-positive catheterization laboratory activations due to PH-ECG.
- To evaluate time intervals from first medical contact to reperfusion.
- To establish the percentage of patients receiving reperfusion within 60 minutes.
Main Methods:
- Retrospective cohort study including 4298 patients with transmitted PH-ECGs in 2013.
- Analysis of catheterization laboratory activations and time intervals for STEMI patients.
Main Results:
- Only 3.2% of patients had STEMI; 16% of pre-hospital activations for STEMI were false-positive.
- Median time from emergency call to arterial puncture was 76 minutes.
- 83% of patients achieved Percutaneous Coronary Intervention (PCI) within 60 minutes.
Conclusions:
- PH-ECG has a low false-positive activation rate, making the 60-minute PCI target achievable for most STEMI patients.
- Reducing time from ambulance arrival to PH-ECG transmission, particularly for female patients, is recommended.
Objective:
The use of pre-hospital ECGs (PH-ECG) reduces time to reperfusion for patients with ST-segment elevation myocardial infarction (STEMI). The feasibility of reperfusion therapy within 60 minutes for hospitals with 24/7 PCI capability has been questioned, and current guidelines have set time targets to 90 minutes. Our primary objective was to investigate the proportion of false-positive catheterization laboratory activations by PH-ECG. Our secondary objective was to describe the time intervals from first medical contact to reperfusion and to establish the proportion of patients receiving reperfusion within 60 minutes.
Design:
A retrospective cohort study among 4298 patients for whom a PH-ECG was transmitted to the investigating hospital, mainly due to chest pain, during 2013 were included.
Results:
Among patients with PH-ECGs, 139 (3.2%) patients had a STEMI. There were 115 pre-hospital catheterization laboratory activations among which 16% (95% confidence interval 10-23) were false-positive for STEMI. The median total time from emergency call to arterial puncture was 76 minutes. The target of PCI within 60 minutes was met in 83% of the cases. The time from EMS arrival to PH-ECG was 20 minutes for female patients and 13 minutes for male patients (p < .001), and only 16% had a PH-ECG within 10 minutes from Emergency Medical Service arrival.
Conclusion:
The rate of false-positive catheterization laboratory activations based on pre-hospital ECGs was low and the target of PCI within 60 minutes is achievable for a majority of patients. Efforts should be made to reduce the time from ambulance arrival to PH-ECG transmission, especially for female patients.
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