Abstract 2090: Initial ECG Acquisition within 10 Minutes of Arrival to the Emergency Department in Persons Presenting with Ischemic Symptoms: Frequency, Time, and Gender Differences
The American Heart Association recommends all patients presenting to the emergency department (ED) with complaints of chest pain/anginal equivalent symptoms receive an initial ECG within 10 minutes of presentation. The ST SMART Study (Synthesized Twelve-lead ST Monitoring & Real-time Tele-electrocardiography) is a prospective randomized clinical trial that enrolls all subjects who call 911 for ischemic complaints in Santa Cruz County, CA. ST-SMART is a 5-year study ending in 2008. The primary aim of the study is to determine if subjects who receive prehospital ECG have more timely hospital intervention and better outcomes.
Objective: The aim of this secondary analysis was to determine:
the frequency of subjects receiving initial hospital ECG within the recommended 10 minutes and
if there were gender differences in meeting this goal.
Methods: Subjects are transported to one of two community hospitals in Santa Cruz County. All subjects receive an initial hospital ECG after arrival to the ED.
Results: In this analysis of 425 patients (mean age, 70.4, 53% male), mean time for all subjects from ED arrival to initial ECG was 43 mins (±145). Mean time to initial ECG was 34 mins (±125) in males vs. 53 mins (±165) in females (Mann-Whitney U, p= .001). 41% of all patients presenting with ischemic symptoms received initial ECG within 10 minutes of arrival. 49% of males vs 32% of females received initial ECG ≤ 10 minutes (Fisher’s Exact test, p=.000).
Conclusion: In this analysis, the majority of patients with ischemic symptoms did not receive an ECG within 10 minutes of hospital presentation as recommended in evidence-based guidelines. There is a significant increase of delay in time to ECG acquisition for women. Clinicians should focus on establishing processes to decrease time to initial ECG for patients with ischemic symptoms. Attention to timely ECG acquisition in women may improve treatment of acute coronary syndromes in this group.