Importance and limits of pre-hospital electrocardiogram in patients with ST elevation myocardial infarction undergoing percutaneous coronary angioplasty

Alessandro Martinoni, Stefano De Servi, Enrico Boschetti, Roberto Zanini, Tullio Palmerini, Alessandro Politi, Giuseppe Musumeci, Guido Belli, Marcella De Paolis, Federica Ettori, Emanuela Piccaluga, Diego Sangiorgi, Alessandra Repetto, Maurizio D'Urbano, Battistina Castiglioni, Franco Fabbiocchi, Marco Onofri, Nicoletta De Cesare, Giuseppe Sangiorgi, Corrado LettieriFabrizio Poletti, Salvatore Pirelli, Silvio Klugmann

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The purpose of this study is to present data on the effects of pre-hospital electrocardiogram (PH-ECG) on the outcome of ST elevation myocardial infarction (STEMI) patients treated with percutaneous coronary angioplasty (PCI) included in a registry undertaken in the Italian region of Lombardy. Pre-hospital 12-lead electrocardiogram is recommended by current guidelines in order to achieve faster times to reperfusion in patients with STEMI. Methods: The registry includes 3901 STEMI patients who underwent primary PCI over an 18-month period. Results: Mean age was 63 ± 12 years. Admission through the emergency medical system (EMS) occurred in 1603 patients (40%): they were older, more frequently had previous MI, TIMI flow = 0 at entry and were more frequently in Killip class >1 than patients who were not admitted through the EMS. Among the patients admitted through the EMS, PH-ECG was obtained in 475 patients (12%). These patients had less frequently an anterior MI, but more frequently had absence of TIMI flow at entry than patients whose ECG was not teletransmitted. Moreover, they had a significantly shorter first medical contact-to-balloon time and a trend toward a lower 30-day death rate (5.3% vs 7.9 %, p = 0.06). However, only patients in Killip class 2-3 had a significantly lower mortality when the diagnostic ECG was transmitted, whereas no difference was found in Killip class 1 or Killip class 4 patients. Conclusions: In this registry, PH-ECG significantly decreased first medical contact-to-balloon time. Attempts to achieve faster reperfusion times should be undertaken, as this may result in improved outcome, particularly in patients with mild to moderate symptoms of heart failure.

Original languageEnglish
Pages (from-to)526-532
Number of pages7
JournalEuropean Journal of Cardiovascular Prevention and Rehabilitation
Volume18
Issue number3
DOIs
Publication statusPublished - Jun 2011

Keywords

  • Angioplasty
  • Interventions
  • Myocardial infarction
  • Percutaneous coronary

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Epidemiology

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