Total Ischemic Time Reduced for STEMI Patients When Pre-Hospital ECG Is Obtained

A study published July 25 in the Journal of the American College of Cardiology found that "obtaining a pre-hospital (PH) electrocardiography (ECG) for patients with chest pain minimally prolongs scene and transport times," and for patients with ST-segment elevation myocardial infarction (STEMI), it reduced total ischemic time.


Previous studies have shown PH ECG helps reduce door-to-balloon (D2B) times, but some studies have suggested it may increase total ischemic time by prolonging the time to obtain an ECG at the scene and, thus, offsetting the reduction in D2B time. Based on this, the authors aimed to "measure the impact of obtaining a PH ECG on both the scene and transport times for out-of-hospital patients with chest pain suspected of cardiac origin," as well as the "measure the impact of obtaining a PH ECG on scene and transport times for patients diagnosed with a STEMI."

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Using data from the San Diego, CA Emergency Medical System from January 2003 to April 2008, the scene times and transport times for patients with chest pain were compared before and after implementation of the PH ECG.

The study authors found that out of the 21,742 patients evaluated, "implementation of PG ECG resulted in minimal increases in median scene time (19 min, 10 s vs. 19 min, 28 s, p = 0.002) and transportation time (13 min, 16 s vs. 13 min, 28 s, p = 0.007). However, compared with chest pain patients, in STEMI patients (n = 303), shorter median scene time (17 min, 51 s vs. 19 min, 31 s, p < 0.001), transport time (12 min, 34 s vs. 13 min, 31 s, p = 0.006), and scene-to-hospital time was observed (30 min, 45 s vs. 33 min, 29 s, p < 0.001)."


"Obtaining a PH ECG by emergency medical personnel for patients with chest pain suspected of cardiac origin adds trivial time at the scene and during transport to the hospital," note the authors. "These findings support the use of PH ECG for all emergency medical service response patients experiencing chest pain."

Further, when compared with all chest pain patients, for patients with a STEMI on a PH ECG, both of these time intervals are shorter and "compliment the benefits of previously established reductions in D2B times with a PH ECG," add the authors.

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