Pre-hospital 12-lead ECG may improve short-term mortality and time to primary cardiac intervention in patients suffering acute myocardial infarct.

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• Julian Nam, Kyla Caners, James M Bowen, Michelle Welsford, and Daria O'Reilly.
• Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. Electronic address: namj5@mcmaster.ca.
• Ann Emerg Med. 2014 Aug 1; 64 (2): 176-86, 186.e1-9.

Study ObjectiveTo present a review of out-of-hospital identification of ST-segment elevation myocardial infarction patients transported by emergency medical services with 12-lead ECG and advance notification versus standard or no cardiac monitoring.MethodsEMBASE, PubMed, and the Cochrane Library were searched, using controlled vocabulary and keywords. Randomized controlled trials and observational studies were included. Outcomes included short-term mortality (≤30 days), door-to-balloon/needle time and/or first medical contact-to-balloon/needle time. Pooled estimates were determined, where appropriate. Results were stratified by percutaneous coronary intervention or fibrinolysis.ResultsThe search yielded 1,857 citations, of which 68 full-texts were reviewed and 16 studies met the final criteria: 15 included data on percutaneous coronary intervention and 3 on fibrinolysis (2 included both). Where percutaneous coronary intervention was performed, out-of-hospital 12-lead ECG and advance notification was associated with a 39% reduction in short-term mortality (8 studies; n=6,339; risk ratio 0.61; 95% confidence interval 0.42 to 0.89; P=.01; I(2)=30%) compared with standard or no cardiac monitoring. Where fibrinolysis was performed, out-of-hospital 12-lead ECG and advance notification was associated with a 29% reduction in short-term mortality (1 study; n=17,026; risk ratio 0.71; 95% confidence interval 0.54 to 0.93; P=.01). First medical contact-to-balloon, door-to-balloon, and door-to-needle times were consistently reduced, though large heterogeneity generally precluded pooling.ConclusionThe present study adds to previous reviews by identifying and appraising the strength and quality of a larger body of evidence. Out-of-hospital identification with 12-lead ECG and aadvance notification was found to be associated with reductions in short-term mortality and first medical contact-to-balloon, door-to-balloon, and door-to-needle time.Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

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