Timothy John Driscoll, Sarah Black, Glenn Davies, Chris P Gale, Lucia Gavalova, Mary Halter, Chelsey Hughes, Scott Munro, Nigel Rees, Andy Rosser, Helen Snooks, Alan Watkins, Clive Weston, Tom Quinn
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Patients who received PHECG were generally younger than those who did not (median age: 70 years vs 75 years), less likely to be female (32.8% vs 41.9%) or to have comorbidities such as diabetes (20.8% vs 24.7%) or peripheral vascular disease (4.1% vs 4.8%). Patients who received PHECG had lower mortality at 30 days (7.1% vs 10.9%), with adjusted OR 0.77 (95% CI 0.75 to 0.80), and at 1 year (14.2% vs 23.2%), with adjusted OR 0.69 (95% CI 0.68 to 0.71). Adjustment accommodated demographic characteristics, comorbidities and medical history. Reperfusion was more frequent in patients with ST-elevation myocardial infarction (STEMI) receiving PHECG (84.5% vs 54.7%) with adjusted OR 4.37 (95% CI 4.20 to 4.54), with similar adjustment.</p><p><strong>Conclusions: </strong>Use of PHECG by EMS for patients with ACS is associated with lower short-term mortality and higher odds of receiving reperfusion for STEMI patients. 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引用次数: 0
摘要
重要性/背景：临床指南推荐12导联心电图用于急诊医疗服务（EMS）疑似急性冠脉综合征（ACS）患者院前评估。目的：确定自英国全国首次经皮冠状动脉介入治疗以来院前心电图（PHECG）的使用情况，以及这是否与ACS患者的临床结果相关。设计：基于人群的关联队列研究，使用心肌缺血国家审计项目2010年1月1日至2017年12月31日的数据，与EMS送往英格兰和威尔士医院的ACS患者相关。暴露：给药。结果：记录PHECG的患者比例，30天和1年全因死亡率，再灌注的使用。结果：在330713例符合条件的EMS转诊患者中，有264420例（79.7%）记录了PHECG，从2010年的74.2%稳步上升至2017年的85.0%。接受PHECG的患者通常比未接受PHECG的患者更年轻（中位年龄：70岁对75岁），女性（32.8%对41.9%）或合并糖尿病（20.8%对24.7%）或周围血管疾病（4.1%对4.8%）的可能性更小。接受PHECG治疗的患者30天死亡率较低（7.1% vs 10.9%），调整后OR为0.77 (95% CI 0.75 - 0.80)， 1年死亡率较低（14.2% vs 23.2%），调整后OR为0.69 （95% CI 0.68 - 0.71）。调整适应了人口统计学特征、合并症和病史。接受PHECG的st段抬高型心肌梗死（STEMI）患者再灌注更为频繁（84.5% vs 54.7%），调整后OR为4.37 (95% CI 4.20 ~ 4.54)，调整后相似。结论：EMS对ACS患者使用PHECG与STEMI患者较低的短期死亡率和较高的再灌注几率相关。随着时间的推移，PHECG的使用稳步增加，但在研究结束时，仍有15%的符合条件的患者没有接受PHECG。
Prehospital 12-lead ECG and outcomes in acute coronary syndrome.
Importance/background: The 12-lead ECG is recommended in clinical guidelines for prehospital assessment of patients with suspected acute coronary syndrome (ACS) presenting to Emergency Medical Services (EMS).
Objectives: To determine prehospital ECG (PHECG) utilisation since UK national rollout of primary percutaneous coronary intervention, and whether this is associated with clinical outcomes in patients with ACS.
Design: Population-based, linked cohort study using Myocardial Ischaemia National Audit Project data from 1 January 2010 to 31 December 2017, related to patients with ACS conveyed by the EMS to hospital in England and Wales.
Exposure: PHECG administration.
Outcomes: Proportion of patients where PHECG was recorded, 30-day and 1 year all-cause mortality, use of reperfusion.
Results: Of 330 713 eligible patients transferred by EMS, 263 420 patients (79.7%) had PHECG recorded, steadily increasing from 74.2% in 2010 to 85.0% in 2017. Patients who received PHECG were generally younger than those who did not (median age: 70 years vs 75 years), less likely to be female (32.8% vs 41.9%) or to have comorbidities such as diabetes (20.8% vs 24.7%) or peripheral vascular disease (4.1% vs 4.8%). Patients who received PHECG had lower mortality at 30 days (7.1% vs 10.9%), with adjusted OR 0.77 (95% CI 0.75 to 0.80), and at 1 year (14.2% vs 23.2%), with adjusted OR 0.69 (95% CI 0.68 to 0.71). Adjustment accommodated demographic characteristics, comorbidities and medical history. Reperfusion was more frequent in patients with ST-elevation myocardial infarction (STEMI) receiving PHECG (84.5% vs 54.7%) with adjusted OR 4.37 (95% CI 4.20 to 4.54), with similar adjustment.
Conclusions: Use of PHECG by EMS for patients with ACS is associated with lower short-term mortality and higher odds of receiving reperfusion for STEMI patients. Administration of PHECG increased steadily over time, but at the end of the study, still 15% of eligible patients did not receive a PHECG.
期刊介绍：
Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.
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