Division of Cardiovascular Medicine, University of California, San Diego, CA, USA.
J Am Coll Cardiol. 2012 Aug 28;60(9):806-11. doi: 10.1016/j.jacc.2012.03.071. Epub 2012 Jul 25.
This study sought to measure the impact of pre-hospital (PH) electrocardiography (ECG) on scene-to-hospital time for patients with chest pain of cardiac origin and those with ST-segment elevation myocardial infarction (STEMI).
Pre-hospital ECG decreases door-to balloon (D2B) time for STEMI patients. However, obtaining a PH ECG might prolong scene time. We investigated the impact of obtaining a PH ECG on both scene and transport times for patients with chest pain suspected of cardiac origin.
City of San Diego Emergency Medical System runsheets of patients with chest pain from January 2003 to April 2008 were analyzed. The scene times and transport times were compared before (from January 2003 to December 2005) and after (from January 2006 to April 2008) implementation of the PH ECG. Among patients with a PH ECG, median scene times and transport times were compared in patients with and without STEMI.
There were 21,742 patients evaluated for chest pain during the study period. Implementation of PH ECG resulted in minimal increases in median scene time (19 min, 10 s vs. 19 min, 28 s, p = 0.002) and transport 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 for patients with chest pain minimally prolongs scene and transport times. Further, for STEMI patients, both scene times and transport times are actually reduced leading to a potential reduction in total ischemic time.
本研究旨在测量院前心电图（ECG）对以心源性胸痛和 ST 段抬高型心肌梗死（STEMI）为特征的患者的从现场到医院的时间的影响。
院前心电图可缩短 STEMI 患者的门球时间（D2B）。然而，获取院前 ECG 可能会延长现场时间。我们调查了获取以心源性胸痛为特征的患者的院前 ECG 对现场和转运时间的影响。
分析了 2003 年 1 月至 2008 年 4 月圣地亚哥市紧急医疗系统运行表中以胸痛为特征的患者。比较了在实施院前 ECG 之前（2003 年 1 月至 2005 年 12 月）和之后（2006 年 1 月至 2008 年 4 月）的现场时间和转运时间。在有院前 ECG 的患者中，比较了 STEMI 患者和非 STEMI 患者的中位数现场时间和转运时间。
在研究期间，对 21742 例胸痛患者进行了评估。实施院前 ECG 后，中位数现场时间（19 分钟 10 秒 vs. 19 分钟 28 秒，p = 0.002）和转运时间（13 分钟 16 秒 vs. 13 分钟 28 秒，p = 0.007）仅略有增加。然而，与胸痛患者相比，在 STEMI 患者（n = 303）中，中位数现场时间（17 分钟 51 秒 vs. 19 分钟 31 秒，p < 0.001）、转运时间（12 分钟 34 秒 vs. 13 分钟 31 秒，p = 0.006）和从现场到医院的时间更短（30 分钟 45 秒 vs. 33 分钟 29 秒，p < 0.001）。
为胸痛患者获取院前 ECG 仅略微延长现场和转运时间。此外，对于 STEMI 患者，现场时间和转运时间实际上都缩短了，从而潜在地减少了总缺血时间。
