Abstract
AimsIn pre-hospital settings handled by paramedics, identification of patients with myocardial infarction (MI) remains challenging when automated electrocardiogram (ECG) interpretation is inconclusive. We aimed to identify those patients and to get them on the right track to primary percutaneous coronary intervention (PCI).Methods and resultsIn the Rotterdam-Rijnmond region, automated ECG devices on all ambulances were supplemented with a modem, enabling transmission of ECGs for online expert interpretation. The diagnostic protocol for acute chest pain was modified and monitored for 1 year.Patients with an ECG that met the criteria for ST-elevation myocardial infarction (STEMI) were immediately transported to a PCI hospital. ECGs that did not meet the STEMI criteria, but showed total ST deviation ≥800 µv were transmitted for online interpretation by the ECG expert. Online supervision was offered as a service if ECGs showed conduction disorders, or had an otherwise ‘suspicious’ pattern according to the ambulance paramedics.We enrolled 1,076 patients with acute ischaemic chest pain who did not meet the automated STEMI criteria. Their mean age was 63 years; 64% were men. After online consultation, 735 (68%) patients were directly transported to a PCI hospital for further treatment. PCI within 90 min was performed in 115 patients.ConclusionDuring a 1-year evaluation of the modified pre-hospital triage protocol for patients with acute ischaemic chest pain, over 100 acute MI patients with an initially inconclusive ECG received primary PCI within 90 min. Because of these results, we decided to continue the operation of the modified protocol.
Highlights
In patients presenting with acute chest pain suggestive of ongoing myocardial infarction (MI) early diagnosis and revascularisation treatment leads to favourable clinical out-Neth Heart J (2018) 26:562–571 comes
Minimising total ischaemic time is the key to improve the prognosis of ST-elevation myocardial infarction (STEMI) patients and highrisk NSTE-ACS patients, which is mainly a logistical challenge that starts in the pre-hospital setting
We initiated our project because we obtained anecdotical reports of patients with acute ischaemic chest pain in our region with an initially inconclusive ECG, who were transported to a non-percutaneous coronary intervention (PCI) centre, and who underwent immediate PCI for acute MI
Summary
In patients presenting with acute chest pain suggestive of ongoing myocardial infarction (MI) early diagnosis and revascularisation treatment leads to favourable clinical out-Neth Heart J (2018) 26:562–571 comes. In patients presenting with acute chest pain suggestive of ongoing myocardial infarction (MI) early diagnosis and revascularisation treatment leads to favourable clinical out-. Patients with ST-elevation myocardial infarction (STEMI) benefit most from percutaneous coronary intervention (PCI) when performed within 2 h after symptom onset [1,2,3]. In the Netherlands, early mortality was reported to be as low as 1.6% in patients who receive PCI treatment in the first hour after symptom onset, compared with 4.0% in those treated after 5 h [4]. In the majority of patients presenting with symptoms suggestive of ongoing MI in a pre-hospital setting an ECG will be obtained by the emergency medical service (EMS). Patients with an inconclusive ECG are transported to non-PCI hospitals for further diagnosis and treatment
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