Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Robert-Koch Str. 40, 37075, Göttingen, Germany.
Department of Cardiology and Pneumology, University Medical Center, University of Göttingen, Göttingen, Germany.
Crit Care. 2018 Feb 7;22(1):29. doi: 10.1186/s13054-017-1929-1.
Non-ST elevation myocardial infarction (NSTEMI) is a common manifestation of acute coronary syndrome (ACS), but delayed diagnosis can increase mortality. In this proof of principle study, the emergency physician performed transthoracic echocardiography (TTE) on scene to determine whether NSTEMI could be correctly diagnosed pre-hospitalization. This could expedite admission to the appropriate facility and reduce the delay until initiation of correct therapy.
Pre-hospital TTE was performed on scene by the emergency physician in patients presenting with ACS but without ST-elevation in the initial 12-lead electrocardiography (ECG) (NSTE-ACS). A presumptive NSTEMI diagnosis was made if regional wall motion abnormalities (RWMA) were detected. These patients were admitted directly to a specialist cardiac facility. Patient characteristics and pre-admission and post-admission clinical, pre-hospital TTE data, and therapeutic measures were recorded.
Patients with NSTE-ACS (n = 53; 72.5 ± 13.4 years of age; 23 female) were studied. The 20 patients with pre-hospital RWMA and presumptive NSTEMI, and two without RWMA were conclusively diagnosed with NSTEMI in hospital. Percutaneous coronary intervention was performed in 50% of the patients presumed to have NSTEMI immediately after admission. The RWMA seen before hospital TTE corresponded with the in-hospital ECG findings and/or the supply regions of the occluded coronary vessels seen during PCI in 85% of the cases. The diagnostic sensitivity of pre-hospital TTE for NSTEMI was 90.9% with 100% specificity.
Pre-hospital transthoracic echocardiography by the emergency physician can correctly diagnose NSTEMI in more than 90% of cases. This can expedite the initiation of appropriate therapy and could thereby conceivably reduce morbidity and mortality.
Deutsche Register klinischer Studien, DRKS00004919 . Registered on 29 April 2013.
非 ST 段抬高型心肌梗死（NSTEMI）是急性冠脉综合征（ACS）的常见表现，但延迟诊断会增加死亡率。在这项原理验证研究中，急诊医生在现场进行了经胸超声心动图（TTE）检查，以确定是否可以在院前正确诊断 NSTEMI。这可以加快患者进入适当医疗机构的速度，并减少开始正确治疗的延迟。
对初诊心电图（ECG）无 ST 段抬高的 ACS 患者（NSTE-ACS）在现场由急诊医生进行院前 TTE。如果检测到区域性壁运动异常（RWMA），则做出疑似 NSTEMI 诊断。这些患者被直接收入专科心脏病房。记录患者特征、入院前和入院后临床、院前 TTE 数据和治疗措施。
研究了 53 例 NSTE-ACS 患者（72.5±13.4 岁；23 名女性）。20 例有院前 RWMA 和疑似 NSTEMI 的患者以及 2 例无 RWMA 的患者在入院后被明确诊断为 NSTEMI。入院后立即对 50%的疑似 NSTEMI 患者进行了经皮冠状动脉介入治疗。院前 TTE 所见的 RWMA 与入院后心电图发现和/或 PCI 期间观察到的闭塞冠状动脉供应区域相符，符合率为 85%。院前 TTE 对 NSTEMI 的诊断敏感性为 90.9%，特异性为 100%。
急诊医生的院前经胸超声心动图可以正确诊断超过 90%的 NSTEMI 病例。这可以加快适当治疗的启动，从而可以减少发病率和死亡率。
德国临床试验注册中心，DRKS00004919。注册于 2013 年 4 月 29 日。
