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  • 03 The prehospital 12 lead electrocardiogram is associated with improved outcomes in patients with acute coronary syndromes presenting to emergency medical services: a nationwide linked cohort study

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03 The prehospital 12 lead electrocardiogram is associated with improved outcomes in patients with acute coronary syndromes presenting to emergency medical services: a nationwide linked cohort study
  1. Tom Quinn2,
  2. Timothy Driscoll1,
  3. Lucia Gavalova2,
  4. Mary Halter2,
  5. Chris P Gale3,
  6. Clive FM Weston4,
  7. Alan Watkins1,
  8. Scott Munro5,
  9. Glenn Davies2,
  10. Chelsey Hampton1,
  11. Andy Rosser6,
  12. Nigel Rees7,
  13. Sarah Black8,
  14. Helen A Snooks1
  1. 1Swansea University, UK
  2. 2Kingston University and St Georges University of London, UK
  3. 3University of Leeds, UK
  4. 4Glangwili General Hospital, Carmarthen, UK
  5. 5South East Coast Ambulance Service NHS Foundation Trust, UK
  6. 6West Midlands Ambulance Service University NHS Foundation Trust, UK
  7. 7Welsh Ambulance Service NHS Trust, UK
  8. 8South Western Ambulance Service NHS Foundation Trust, UK

Abstract

Background Use of the Pre-Hospital 12-lead Electrocardiogram (PHECG) is recommended in patients presenting to emergency medical services (EMS) with suspected acute coronary syndrome (ACS).

Objectives To investigate differences in mortality between those who did/did not receive PHECG.

Methods Population-based, linked cohort study using Myocardial Ischaemia National Audit Project (MINAP) data from 2010-2017.

Results Of 330,713 patients, 263,420 (79.6%) had PHECG, 67,293 (20.3%) did not. 30-day mortality was 7.8% overall, 7.1% with PHECG vs 10.9% without PHECG (adjusted Odds Ratio [aOR] 0.772, 95% confidence interval [CI] 0.748-0.795, p<0.001). 1 year mortality was 16.1% overall, 14.2% with PHECG vs 23.2% without (aOR 0.692, 95% CI 0.676-0.708, p<0.001). 144,254 patients had ST segment elevation myocardial infarction (STEMI); 130,240 (90.2%) had PHECG, 30 day mortality 8.8% overall, 8.0% with PHECG vs 15.9% without (aOR 0.588, 95% CI 0.557-0.622, p<0.001), 1 year mortality 13.1% overall, 12.1% with PHECG vs 22.8% without (aOR 0.585, 95% CI 0.557-0.614, p<0.001). 186,459 patients had non-STEMI; 133,180 (71.4%) had PHECG. 30-day mortality 7.1% overall, 6.1% with PHECG vs 9.6% without (aOR 0.677, 95%CI 0.652-0.704, p<0.001), 1 year mortality 18.3% overall, 16.3% with PHECG vs 23.3% without (aOR 0.694, 95% CI 0.676-0.713, p<0.001). 110,571 STEMI patients received primary PCI, 103,741 (93.8%) had PHECG. 30 day mortality 5.4% overall, 5.3% with PHECG vs 7.0% without (aOR 0.739, 95% CI 0.667-0.829, p<0.001). 1 year mortality 8.5% overall, 8.4% with PHECG vs 9.8% without (aOR 0.833, 95% CI 0.762-0.911, p<0.001). 26,127 (18.1%) STEMI patients received no reperfusion; 19,873 (76%) had PHECG. Mortality at 30 days 22.1% overall, 21.3% with PHECG vs 24.7% without (aOR 0.911, 95% CI 0.847-0.980, p=0.013), 1 year mortality 32.2% overall, 30.9% with PHECG, 36.4% without (aOR 0.865, 95% CI 0.810-0.925, p<0.001).

Conclusion PHECG was associated with lower mortality at 30 days and 1 year in both STEMI and non-STEMI patients.

https://doi.org/10.1136/emermed-2021-999.3

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