Journal article
Use of Prehospital 12-Lead Electrocardiography and Treatment Times Among ST-Elevation Myocardial Infarction Patients With Atypical Symptoms
Academic emergency medicine, v 21(8), pp 892-898
Aug 2014
PMID: 25155289
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Objectives Guidelines advise that a prehospital electrocardiogram (ECG) should be obtained in any patients with chest pain, yet up to 20% of patients with ST-elevation myocardial infarction (STEMI) do not present with chest pain. The objective was to determine the association of atypical presentations in the prehospital setting on the likelihood of receiving a prehospital ECG and subsequent time to reperfusion therapy. Methods This study used a data set that linked prehospital medical information from a statewide EMS data system with a clinical registry of treatment and outcomes data for patients with STEMI. Among 2,639 STEMI patients from 2008 to 2010, the association between non-chest pain presentations, prehospital ECG use, and reperfusion times among patients undergoing primary percutaneous coronary intervention (PCI) were examined. Inverse probability weights were used to account for observed baseline confounders. Results Overall, 318 of 2,639 patients (12.1%) presented without chest pain. A prehospital ECG was obtained in 2,021 of 2,321 (87.1%) patients with chest pain compared with only 230 of 318 (72.3%) without chest pain (odds ratio [OR]= 2.24, 95% confidence interval [CI]=1.69 to 2.98). Among patients without chest pain, those who received a prehospital ECG had significantly shorter first medical contact (FMC) to device times (30.9%<90minutes vs. 11.4% > 90minutes, adjusted OR= 2.81, 95% CI=1.29 to 6.11, p<0.01). Conclusions Over one-quarter of STEMI patients presenting without chest pain did not receive prehospital ECGs and had significantly longer FMC to device times. Future efforts are needed to promote the use of prehospital ECGs to achieve more rapid identification of STEMI patients with atypical presentations in the prehospital setting.
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Details
- Title
- Use of Prehospital 12-Lead Electrocardiography and Treatment Times Among ST-Elevation Myocardial Infarction Patients With Atypical Symptoms
- Creators
- Austin R. Cannon - University of North Carolina at Chapel HillLi Lin - Clinical Research InstituteBarbara Lytle - Clinical Research InstituteEric D. Peterson - Clinical Research InstituteCharles B. Cairns - University of North Carolina at Chapel HillSeth W. Glickman - University of North Carolina at Chapel Hill
- Publication Details
- Academic emergency medicine, v 21(8), pp 892-898
- Publisher
- Wiley
- Number of pages
- 7
- Grant note
- T35DK007386 / NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) T35-DK007386 / National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:000341640800009
- Scopus ID
- 2-s2.0-84906301566
- Other Identifier
- 991021448192904721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Emergency Medicine