Prehospital Predictors of Atypical STEMI Symptoms
Tyson G Taylor1, Ronald E Stickney1, William J French1
1Stryker Corporation, Torrance, California (TGT, RES); Harbor-UCLA Medical Center, Torrance, California (WJF, JTN, NB); The Lundquist Institute, Torrance, California (WJF, JTN, NB); The David Geffen School of Medicine at UCLA, Los Angeles, California (WJF, JTN, NB); North Carolina Heart and Vascular, UNC Healthcare, Chapel Hill, North Carolina (JGJ); Internal Medicine, Virginia Commonwealth University, Richmond, Virginia (MCK); Los Angeles County-USC Medical Center, Los Angeles, California (SGS, MKE); Los Angeles Fire Department, Los Angeles, California (SGS); Emergency Medicine,USC School of Medicine, Los Angeles, California (MKE); Los Angeles County EMS Agency, Santa Fe Springs, California (MKE, NB).
Insights
Limiting prehospital 12-lead ECGs to typical ST-elevation myocardial infarction (STEMI) symptoms delays care for 20% of patients. Older age and Black race are associated with atypical STEMI presentations, impacting recognition and treatment.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Rapid identification of ST-elevation myocardial infarction (STEMI) is crucial for timely treatment.
- Broad prehospital 12-lead ECG screening risks false STEMI activations due to low prevalence.
- Limiting ECGs to typical STEMI symptoms may delay care for atypical presentations, potentially causing health disparities.
Purpose of the Study:
- To assess patient factors associated with atypical STEMI presentation.
- To evaluate the impact of symptom-based ECG acquisition on STEMI recognition.
Main Methods:
- Retrospective analysis of adult patients with field 12-lead ECGs obtained by Los Angeles Fire Department paramedics.
- Identification of STEMI patients using a regional STEMI receiving center registry.
- Logistic regression analysis to determine patient factors (age, sex, race) associated with atypical STEMI presentation.
Main Results:
- Of 586 STEMI patients, 20% presented with atypical symptoms.
- Older age (OR 1.05 per year) and Black race (OR vs. White 2.18) were independently associated with atypical STEMI presentation in multivariable analysis.
- Women with STEMI were older than men, and older age and female sex were univariate predictors of atypical symptoms.
Conclusions:
- Restricting prehospital 12-lead ECGs to typical STEMI symptoms would delay recognition for one in five STEMI patients.
- This approach disproportionately affects older patients, women, and Black patients.
- Older age appears to be a more significant predictor of atypical STEMI presentation than sex.
Abstract:
Introduction: Rapid prehospital identification of patients with ST-elevation myocardial infarction (STEMI) is a critical step to reduce time to treatment. Broad screening with field 12-lead ECGs can lead to a high rate of false positive STEMI activations due to low prevalence. One strategy to reduce false positive STEMI interpretations is to limit acquisition of 12-lead ECGs to patients who have symptoms strongly suggestive of STEMI, but this may delay care in patients who present atypically and lead to disparities in populations with more atypical presentations. We sought to assess patient factors associated with atypical STEMI presentation.Methods: We retrospectively analyzed consecutive adult patients for whom Los Angeles Fire Department paramedics obtained a field 12-lead ECG from July 2011 through June 2012. The regional STEMI receiving center registry was used to identify patients with STEMI. Patients were designated as having typical symptoms if paramedics documented provider impressions of chest pain/discomfort, cardiac arrest, or cardiac symptoms, otherwise they were designated as having atypical symptoms. We utilized logistic regression to determine patient factors (age, sex, race) associated with atypical STEMI presentation.Results: Of the 586 patients who had STEMI, 70% were male, 43% White, 16% Black, 20% Hispanic, 5% Asian and 16% were other or unspecified race. Twenty percent of STEMI patients (n = 117) had atypical symptoms. Women who had STEMI were older than men (74 years [IQR 62-83] vs. 60 years [IQR 53-70], p < 0.001). Univariate predictors of atypical symptoms were older age and female sex (p < 0.0001), while in multivariable analysis older age [odd ratio (OR) 1.05 per year, [95%CI 1.04-1.07, p < 0.0001] and black race (OR vs White 2.18, [95%CI 1.20-3.97], p = 0.011) were associated with atypical presentation.Conclusion: Limiting prehospital acquisition of 12-lead ECGs to patients with typical STEMI symptoms would result in one in five patients with STEMI having delayed recognition, disproportionally impacting patients of older age, women, and Black patients. Age, not sex, may be a better predictor of atypical STEMI presentation.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
07:25Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management
01:29Pulmonary Embolism I: Introduction