Abstract 16647: The Value of Normal Electrocardiography Acquired in the Prehospital Setting for Triage Decision Making

Abstract

Introduction: Acquisition of prehospital ECG (PH ECG) is becoming the standard of care for patients activating emergency medical services (EMS) for symptoms of acute coronary syndrome (ACS). Little is known about the value of completely normal PH ECG findings (no ST-T wave changes, arrhythmias, bundle branch block, first degree block, left ventricular hypertrophy, long QT interval, or abnormal axis deviation) in patients with symptoms of ACS. The ST SMART Study was a prospective randomized clinical trial that enrolled all patients who activated 911 for ischemic complaints in Santa Cruz County, CA.

Objectives: This secondary analysis was to: 1) determine the proportion of patients transported for ischemic complaints with completely normal PH ECG findings, and 2) describe short (in-hospital complications) and long-term outcomes (death) in this population.

Methods: All patients received 12-lead ECG monitoring with specialized ischemia monitoring software in the prehospital setting.

Results: In this analysis of 630 patients (mean age, 69.8, 51.7% male), a total of 67 (10.6%) patients with ischemic symptoms had completely normal PH ECG. There were significant differences in outcomes between those with normal PH ECG and those with any PH ECG abnormalities (Table 1).

Discussion: Patients who activate EMS for ACS symptoms with completely normal PH ECG findings have significantly less in-hospital complications and long-term mortality. EMS and clinicians should consider normal PH ECG findings in their triage decisions of patients transported by ambulance for ischemic complaints. PH ECG findings allow for immediate triage and risk stratification across the spectrum of patients with ACS complaints.