Abstract 31: Clinical Utility of Prehospital 12-Lead Electrocardiogram in the Management of Patients With Acute Coronary Syndrome in Japan
Introduction: The prehospital 12-lead electrocardiogram (prehospital-ECG) is beneficial for patients with ST elevation acute coronary syndrome (STE-ACS) to decrease door to balloon time, and is recommended by the AHA/ACC guidelines. However, it is unclear that if prehospital-ECG improves the management of patients with STE-ACS in Japanese urban area.
Hypothesis: We assessed the utility of prehospital-ECGs in the management of patients with STE-ACS in Yokohama, Japan.
Methods: 470 consecutive patients (age 63.7 ± 11.8, male 82 %) with STE-ACS who were referred to our institution, which is a tertiary emergency center in Yokohama, were included. First, we assessed the utility of prehospital-ECGs for 412 patients who were directly admitted from the scene by emergency medical technicians (EMT) with (n = 246) or without (n = 166) prehospital-ECGs. Second, we investigated differences between patients directly admitted to our institution from the scene by EMT (n = 412) and patients transferred to our institution from other hospitals without percutaneous coronary intervention facilities (n = 58).
Results: Symptom-onset to balloon time (minutes) was significantly shorter in patients with prehospital-ECGs than in patients without prehospital-ECG (113 [93 – 150] versus 130 [91 – 175], P = 0.04). 58 patients transferred to our institution from other hospitals had longer symptom-onset to balloon time (minutes) (225 [179 – 296] versus 120 [91 – 164], P < 0.001), and higher peak creatine kinase values (2778 [1702 – 4366] versus 1794 [753 – 3663], P = 0.008) compared to patients directly admitted from the scene. Multivariate logistic regression analysis revealed that higher age (odds ratio 1.08, 95 % confidence interval 1.04 – 1.12, P < 0.001) and daytime ACS onset (odds ratio 2.97, 95 % confidence interval 1.39 – 6.37, P = 0.005) were significantly associated with transfer from hospitals without urgent cardiac catheterization facilities.
Conclusions: Symptom-onset to balloon time was significantly decreased in patients who received prehospital-ECGs at a tertiary emergency center in Yokohama. In addition, implementing prehospital-ECGs more aggressively in high age patients and patients with daytime ACS onset might improve the management of patients with STE-ACS.
- © 2010 by American Heart Association, Inc.