Normal prehospital electrocardiography is linked to long-term survival in patients presenting to the emergency department with symptoms of acute coronary syndrome

• Published in: Journal of electrocardiology Vol. 48; no. 4; pp. 520 - 526
• Main Authors: Zègre-Hemsey, Jessica K., PhD, RN, Sommargren, Claire E., PhD, RN, Asafu-Adjei, Josephine K., PhD, Drew, Barbara J., PhD, RN
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2015
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - mortality; Aged; California - epidemiology; Cardiovascular; Electrocardiography - methods; Electrocardiography - statistics & numerical data; Emergency medical services; Emergency Medical Services - methods; Emergency Medical Services - statistics & numerical data; Emergency Service, Hospital - statistics & numerical data; Female; Humans; Incidence; Male; Prehospital electrocardiography; Prognosis; Reference Values; Reproducibility of Results; Risk Assessment - methods; Sensitivity and Specificity; ST-segment monitoring; Survival Rate; Survivors - statistics & numerical data; Triage - methods; Triage - statistics & numerical data; California; Prehospital electrocardiography; Acute coronary syndrome; Emergency medical services; ST-segment monitoring
• DOI: 10.1016/j.jelectrocard.2015.01.014
• ISSN: 0022-0736

Abstract Aims/methods We studied 735 patients who activated "911" for chest pain and/or anginal equivalent symptoms and received 12-lead ECG monitoring with specialized ischemia monitoring software in the ambulance. Prehospital electrocardiograms (PH ECG) were analyzed to determine the proportion of patients who present with completely normal PH ECG findings (absence of ischemia/infarction, arrhythmia, or any other abnormality) and to compare outcomes among patients with and without any PH ECG abnormality. Results Of 735 patients (mean age 70.5, 52.4% male), 68 (9.3%) patients had completely normal PH ECG findings. They experienced significantly less adverse hospital outcomes (12% vs 37%), length of stay (1.19 vs 3.86 days), and long-term mortality (9% vs 28%) than those with any PH ECG abnormality (p < .05). Conclusion Normal PH ECG findings are associated with better short and long-term outcomes in ambulance patients with ischemic symptoms. These findings may enhance early triage and risk stratification in emergency cardiac care.