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Prehospital ECG linked to improved survival after MI
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Patients with MI who received an ECG test in the ambulance had improved survival rates at 30 days, according to data in a new study.
“While there is evidence from other countries that having an ECG test in the ambulance leads to faster treatment, our study is the first to determine that the test is actually associated with improved survival after a heart attack,” Tom Quinn, MPhil, RN, FESC, FRCN, FAHA, associate dean of health and medical strategy at University of Surrey, United Kingdom, said in a press release.
Quinn and colleagues hypothesized that use of prehospital ECG by emergency medical services systems would be associated with better processes of care and lower mortality rates.
Using data from the Myocardial Ischemia National Audit Project, the researchers analyzed 288,990 patients admitted to 228 UK hospitals with STEMI or non-STEMI via emergency medical services from 2005 to 2009.
ECG linked to better mortality rate
Patients who had a prehospital ECG showed a better 30-day mortality rate compared with those who did not (7.4% vs. 8.2%; adjusted OR=0.94; 95% CI, 0.91-0.96).
For patients with STEMI, reperfusion occurred more frequently in those who had a prehospital ECG than in those who did not (83.5% vs. 74.4%; P<.0001).
Quinn and colleagues also found that treatment was more likely to occur sooner for those who had a prehospital ECG. For patients requiring primary PCI, prehospital ECG was associated with a higher likelihood of achieving call-to-balloon time of less than 90 minutes (prehospital ECG group, 27.9%; no prehospital ECG group, 21.4%; adjusted OR=1.38; 95% CI, 1.24-1.54). For patients requiring fibrinolytic therapy, prehospital ECG was associated with a higher likelihood of achieving door-to-needle time of less than 30 minutes (prehospital ECG group, 90.6%; no prehospital ECG group, 83.7%; adjusted OR=2.13; 95% CI, 1.91-2.38).
From 2005 to 2009, prehospital ECG use increased overall (51% vs. 64%; adjusted OR=2.17; 95% CI, 2.12-2.22) and in patients with STEMI (64% vs. 79%; adjusted OR=2.34; 95% CI, 2.25-2.44), the researchers found.
US use of prehospital ECG low
In contrast, only about one-quarter of patients with MI in the United States receive a prehospital ECG, Quinn said in the press release.
Patients in this study who received a prehospital ECG were younger (71 years vs. 74 years; P<.0001) and less likely to be female (33.1% vs. 40.3%; OR=0.87; 95% CI, 0.86-0.89) compared with those who did not. They were also less likely to have comorbidities and less likely to be from a minority ethnic group, according to the researchers.
“We need to do more to ensure that the groups we identified as not getting the test have improved care,” Quinn said in the press release. “Hopefully our results will reinforce to the paramedics the importance of carrying out an ECG when they suspect a heart attack, as well as flag up the types of patients who are currently less likely to receive this test, making them more vulnerable to poor outcomes.”
Disclosure: The study was funded by the British Heart Foundation. Quinn reports receiving funding from Boehringer Ingelheim, The Medicines Company and the National Institute for Health Research relating to prehospital trials of ACS care. The other researchers report no relevant financial disclosures.
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