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Utilization and impact of pre-hospital electrocardiograms for patients with acute ST-segment elevation myocardial infarction: data from the NCDR (National Cardiovascular Data Registry) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry.

Publication ,  Journal Article
Diercks, DB; Kontos, MC; Chen, AY; Pollack, CV; Wiviott, SD; Rumsfeld, JS; Magid, DJ; Gibler, WB; Cannon, CP; Peterson, ED; Roe, MT
Published in: J Am Coll Cardiol
January 13, 2009

OBJECTIVES: This study sought to determine the association of pre-hospital electrocardiograms (ECGs) and the timing of reperfusion therapy for patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Pre-hospital ECGs have been recommended in the management of patients with chest pain transported by emergency medical services (EMS). METHODS: We evaluated patients with STEMI from the NCDR (National Cardiovascular Data Registry) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) registry who were transported by EMS from January 1, 2007, through December 31, 2007. Patients were stratified by the use of pre-hospital ECGs, and timing of reperfusion therapy was compared between the 2 groups. RESULTS: A total of 7,098 of 12,097 patients (58.7%) utilized EMS, and 1,941 of these 7,098 EMS transport patients (27.4%) received a pre-hospital ECG. Among the EMS transport population, primary percutaneous coronary intervention was performed in 92.1% of patients with a pre-hospital ECG versus 86.3% with an in-hospital ECG, whereas fibrinolytic therapy was used in 4.6% versus 4.2% of patients. Median door-to-needle times for patients receiving fibrinolytic therapy (19 min vs. 29 min, p = 0.003) and median door-to-balloon times for patients undergoing primary percutaneous coronary intervention (61 min vs. 75 min, p < 0.0001) were significantly shorter for patients with a pre-hospital ECG. A suggestive trend for a lower risk of in-hospital mortality was observed with pre-hospital ECG use (adjusted odds ratio: 0.80, 95% confidence interval: 0.63 to 1.01). CONCLUSIONS: Only one-quarter of these patients transported by EMS receive a pre-hospital ECG. The use of a pre-hospital ECG was associated with a greater use of reperfusion therapy, faster reperfusion times, and a suggested trend for a lower risk of mortality.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

January 13, 2009

Volume

53

Issue

2

Start / End Page

161 / 166

Location

United States

Related Subject Headings

  • Time Factors
  • Registries
  • Myocardial Reperfusion
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Fibrinolytic Agents
  • Female
  • Emergency Medical Services
 

Citation

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Diercks, D. B., Kontos, M. C., Chen, A. Y., Pollack, C. V., Wiviott, S. D., Rumsfeld, J. S., … Roe, M. T. (2009). Utilization and impact of pre-hospital electrocardiograms for patients with acute ST-segment elevation myocardial infarction: data from the NCDR (National Cardiovascular Data Registry) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry. J Am Coll Cardiol, 53(2), 161–166. https://doi.org/10.1016/j.jacc.2008.09.030
Diercks, Deborah B., Michael C. Kontos, Anita Y. Chen, Charles V. Pollack, Stephen D. Wiviott, John S. Rumsfeld, David J. Magid, et al. “Utilization and impact of pre-hospital electrocardiograms for patients with acute ST-segment elevation myocardial infarction: data from the NCDR (National Cardiovascular Data Registry) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry.J Am Coll Cardiol 53, no. 2 (January 13, 2009): 161–66. https://doi.org/10.1016/j.jacc.2008.09.030.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

January 13, 2009

Volume

53

Issue

2

Start / End Page

161 / 166

Location

United States

Related Subject Headings

  • Time Factors
  • Registries
  • Myocardial Reperfusion
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Fibrinolytic Agents
  • Female
  • Emergency Medical Services