Utility of prehospital electrocardiogram interpretation in ST-segment elevation myocardial infarction utilizing
Amir Faour1,2, Callum Cherrett1, Oliver Gibbs1
1Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia.
Insights
Prehospital electrocardiogram (PH-ECG) transmission and cardiologist consultation accurately activated cardiac catheter laboratories (CCL-A) for ST-segment elevation myocardial infarction (STEMI), minimizing inappropriate activations.
Area of Science:
- Cardiology
- Emergency Medicine
- Medical Technology
Background:
- Prehospital electrocardiogram (PH-ECG) transmission is crucial for timely ST-segment elevation myocardial infarction (STEMI) diagnosis.
- The effectiveness of PH-ECG in guiding prehospital cardiac catheter laboratory activation (CCL-A) requires further investigation due to conflicting prior studies.
Purpose of the Study:
- To evaluate the appropriateness of prehospital CCL-A for STEMI using the University of Glasgow algorithm (UGA) combined with remote interventional cardiologist consultation.
- To assess the diagnostic accuracy and impact of PH-ECG transmission on CCL-A decisions.
Main Methods:
- A retrospective analysis of 1088 consecutive PH-ECG transmissions between June 2010 and October 2016.
- Blinded adjudication of ECGs, appropriateness of CCL-A, and diagnoses based on the fourth universal definition of MI.
- Primary outcome: appropriate CCL-A rate; Secondary outcomes: rates of false-positive and inappropriate CCL-A/nonactivation.
Main Results:
- Of 1088 PH-ECG transmissions, 565 (52%) resulted in CCL-A and 523 (48%) in CCL nonactivation.
- The appropriate CCL-A rate was high at 97% (550/565), with low false-positive (4.9%) and inappropriate CCL-A (2.7%) rates.
- Common reasons for appropriate CCL nonactivation included nondiagnostic ST-segment elevation, bundle branch block, and repolarization abnormalities.
Conclusions:
- PH-ECG interpretation with UGA and interventional cardiologist consultation accurately identified STEMI, achieving a high appropriate CCL-A rate with minimal false positives.
- Cardiologist consultation identified subtle STEMI cases and prevented unnecessary CCL activations, highlighting its significant benefit.
- This integrated approach optimizes prehospital STEMI management and resource utilization.
Objectives:
We examined the appropriateness of prehospital cardiac catheter laboratory activation (CCL-A) in ST-segment elevation myocardial infarction (STEMI) utilizing the University of Glasgow algorithm (UGA) and remote interventional cardiologist consultation.
Background:
The incremental benefit of prehospital electrocardiogram (PH-ECG) transmission on the diagnostic accuracy and appropriateness of CCL-A has been examined in a small number of studies with conflicting results.
Methods:
We identified consecutive PH-ECG transmissions between June 2, 2010 and October 6, 2016. Blinded adjudication of ECGs, appropriateness of CCL-A, and index diagnoses were performed using the fourth universal definition of MI. The primary outcome was the appropriate CCL-A rate. Secondary outcomes included rates of false-positive CCL-A, inappropriate CCL-A, and inappropriate CCL nonactivation.
Results:
Among 1088 PH-ECG transmissions, there were 565 (52%) CCL-As and 523 (48%) CCL nonactivations. The appropriate CCL-A rate was 97% (550 of 565 CCL-As), of which 4.9% (n = 27) were false-positive. The inappropriate CCL-A rate was 2.7% (15 of 565 CCL-As) and the inappropriate CCL nonactivation rate was 3.6% (19 of 523 CCL nonactivations). Reasons for appropriate CCL nonactivation (n = 504) included nondiagnostic ST-segment elevation (n = 128, 25%), bundle branch block (n = 132, 26%), repolarization abnormality (n = 61, 12%), artefact (n = 72, 14%), no ischemic symptoms (n = 32, 6.3%), severe comorbidities (n = 26, 5.2%), transient ST-segment elevation (n = 20, 4.0%), and others.
Conclusions:
PH-ECG interpretation utilizing UGA with interventional cardiologist consultation accurately identified STEMI with low rates of inappropriate and false-positive CCL-As, whereas using UGA alone would have almost doubled CCL-As. The benefits of cardiologist consultation were identifying "masquerading" STEMI and avoiding unnecessary CCL-As.
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