Normal prehospital electrocardiography is linked to long-term survival in patients presenting to the emergency department with symptoms of acute coronary syndrome

Abstract

Aims/Methods We studied 735 patients who activated “911” for chest pain and/or anginal equivalent symptoms and received 12-lead ECG monitoring with specialized ischemia monitoring software in the ambulance. Prehospital electrocardiograms (PH ECG) were analyzed to determine the proportion of patients who present with completely normal PH ECG findings (absence of ischemia/infarction, arrhythmia, or any other abnormality) and to compare outcomes amongst patients with and without any PH ECG abnormality. Results Of 735 patients (mean age 70.5, 52.4% male), 68 (9.3%) patients had completely normal PH ECG findings. They experienced significantly less adverse hospital outcomes (12% vs 37%), length of stay (1.19 vs 3.86 days), and long-term mortality (9% vs 28%) than those with any PH ECG abnormality (p<.05). Conclusion Normal PH ECG findings are associated with better short and long-term outcomes in ambulance patients with ischemic symptoms. These findings may enhance early triage and risk stratification in emergency cardiac care.

Predictive ability and efficacy for shortening door-to-balloon time of a new prehospital electrocardiogram-transmission flow chart in patients with ST-elevation myocardial infarction – Results of the CASSIOPEIA study

“…To improve the prognosis of patients with ST-elevation myocardial infarction (STEMI), early coronary reperfusion is required, and a door to balloon time (DTBT) within 90 min is recommended in the clinical guidelines for STEMI [1]. DTBT has been shortened by several methods in emergency medicine [2][3][4][5][6]. Recent guidelines have established target first medical contact to device time (FMCTDT) within 90 min and within 120 min from onset to reperfusion [7][8][9].…”

Predictors of emergency medical services use by adults with heart failure; 2009–2017

“…The critical window of time concept of 'door-to-balloon' is well characterized for adults with acute coronary syndromes in which prehospital assessment and treatment have led to rapid assessment and activation of the cardiac catheterization team with improvements in diagnosis and outcomes. 13,14 Less data are available for adults with HF to determine if there is a critical window of time in the prehospital phase for implementation of treatments that would improve diagnosis and survival and reduce morbidity. In a consensus document on prehospital and emergency care for acute HF, Mebazaa and colleagues 12 recommended treatments that should be implemented during the prehospital phase but noted that the recommendations are primarily based on clinical judgment.…”