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Impact of prehospital electrocardiogram on time to treatment and in-hospital outcomes in ST-segment elevation myocardial infarction
Session:
Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker:
SARA ISABEL LOPES FERNANDES
Congress:
CPC 2021
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Sara Lopes Fernandes; Pedro Jerónimo Sousa; Tiago Teixeira; Francisco Soares; Luís Graça Santos; Rita Carvalho; Margarida Cabral; Mariana Carvalho; Hélia Martins; Jorge Guardado; Joao Morais
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Time to treatment is crucial in patients with ST-segment elevation myocardial infarction (STEMI). Delays in diagnosis and reperfusion are associated with worse prognosis.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim: </strong>To determine the impact of prehospital electrocardiogram (PH-ECG) on time to diagnosis and reperfusion and in-hospital clinical outcomes in patients with suspected STEMI.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Prospective study of consecutive patients with suspected STEMI admitted to a single percutaneous coronary intervention (PCI) centre, with emergency medical system (EMS) based prehospital care and transportation. Baseline clinical and demographical data were collected, as well as system delay (time from national emergency number call [NEMC] to reperfusion) and its components. The population was divided in two groups (PH-ECG – group 1; no-PH-ECG – group 2). A clinical endpoint of death, new onset heart failure or presumed new left ventricular dysfunction was compared between groups, and logistic regression was used to assess the impact of PH-ECG on this endpoint.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>Of<strong> </strong>129 patients, 45 were excluded due to non-EMS based prehospital care (mainly self-admission on emergency department). 84 patients were studied, with a mean age of 65 ± 14 years and 61 (73%) were male. 45% of patients (n= 45) had an ECG in the pre-hospital setting. No difference in baseline characteristics was found between groups (table 1). More patients in group 1 were admitted to a PCI-centre (87% vs 63%, p= 0,014); nevertheless, 5 patients in group 1 were initially admitted to a non-PCI centre. Considering time variables, group 1 had lower system delay (178±126 vs 271±169 minutes, p= 0,007), lower time from NEMC to first medical contact (FMC) (28±18 vs 68±38 minutes, p<0,001), lower time from FMC to ECG (12±13 vs 58±90 minutes, p=0.001), but no difference regarding FMC to reperfusion time (150±119 vs 208±158 minutes, p=0,065). Considering clinical outcomes, PH-ECG was associated with a lower incidence of the composite endpoint (32% vs 54%; p=0.048). After multivariate adjustment, PH-ECG remained an independent predictor of reduced composite endpoint (OR 0.388, 95% CI 0,158-0,951, p=0,038).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>PH-ECG is associated with better system performance and clinical outcomes in STEMI patients, however it is significantly underused. Local and national strategies and relevant policies should be urgently adopted to promote widespread expedited PH-ECG use.</span></span></p>
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