Sahlgrenska University Hospital, Östra Sjukhuset, Department of Emergency Medicine, Göteborg, Sweden.
Department of Medicine, University of Gothenburg, Göteborg, Sweden.
Int J Cardiol. 2017 Dec 1;248:77-81. doi: 10.1016/j.ijcard.2017.06.032. Epub 2017 Aug 30.
In the assessment of patients with chest pain, there is support for the use of pre-hospital ECG in the literature and in the care guidelines. Using propensity score methods, we aim to examine whether the mere acquisition of a pre-hospital ECG among patients with chest pain affects the outcome (30-day mortality).
The association between pre-hospital ECG and 30-day mortality was studied in the overall cohort (n=13151), as well as in the one-to-one matched cohort with 2524 patients not examined with pre-hospital ECG and 2524 patients examined with pre-hospital ECG.
In the overall cohort, 21% (n=2809) did not undergo an ECG tracing in the pre-hospital setting. Among those who had pain during transport, 14% (n=1159) did not undergo a pre-hospital ECG while 32% (n=1135) of those who did not have pain underwent an ECG tracing. In the overall cohort, the OR for 30-day mortality in patients who had a pre-hospital ECG, as compared with those who did not, was 0.63 (95% CI 0.05-0.79; p<0.001). In the matched cohort, the OR was 0.65 (95% CI 0.49-0.85; p<0.001). Using the propensity score, in the overall cohort, the corresponding HR was 0.65 (95% CI 0.58-0.74).
Using propensity score methods, we provide real-world data demonstrating that the adjusted risk of death was considerably lower among the cases in whoma pre-hospital ECG was used. The PH-ECG is underused among patients with chest discomfort and the mere acquisition of a pre-hospital ECG may reduce mortality.
在评估胸痛患者时，文献和护理指南都支持在院前进行心电图检查。我们采用倾向评分方法，旨在检验胸痛患者接受院前心电图检查是否会影响结局（30 天死亡率）。
我们在整体队列（n=13151）以及一对一匹配队列（n=2524 例未行院前心电图检查的患者和 2524 例行院前心电图检查的患者）中研究了院前心电图与 30 天死亡率之间的关系。
整体队列中，21%（n=2809）的患者未在院前进行心电图检查。在转运过程中出现疼痛的患者中，14%（n=1159）未行院前心电图检查，而在无疼痛的患者中，32%（n=1135）进行了心电图检查。在整体队列中，与未行院前心电图检查的患者相比，行院前心电图检查的患者 30 天死亡率的 OR 为 0.63（95%CI 0.05-0.79；p<0.001）。在匹配队列中，OR 为 0.65（95%CI 0.49-0.85；p<0.001）。使用倾向评分，在整体队列中，相应的 HR 为 0.65（95%CI 0.58-0.74）。
我们采用倾向评分方法提供了真实世界的数据，表明在使用院前心电图检查的病例中，死亡风险的调整后显著降低。在胸痛患者中，院前心电图检查的应用不足，而仅仅进行院前心电图检查就可能降低死亡率。
