1 Clinical Research Laboratory, Institute of Cardiology/University Foundation of Cardiology, Porto Alegre, Brazil.
2 InCor Hypertension Unit, School of Medicine of the University of Sao Paulo, Porto Alegre, Brazil.
Telemed J E Health. 2019 Mar;25(3):199-204. doi: 10.1089/tmj.2017.0277. Epub 2018 Jul 5.
Tele-electrocardiography (tele-ECG) is a powerful ally in the screening of acute ischemic lesions.
Evidence that confirms the correlation between the diagnosis of acute coronary syndrome (ACS) determined in the prehospital setting and the confirmation of the diagnosis in the hospital setting is scarce. This study compares the presumed diagnosis of ACS in the prehospital setting based on electrocardiographic changes, such as ST-segment deviation, with the diagnosis confirmed in a hospital setting.
Retrospective, cross-sectional analysis of medical records of patients who sought emergency ambulance services of a distinguished public healthcare service in the city of Porto Alegre from September 2013 to August 2014. Data were collected from tele-ECG recordings and medical records available at the database of the Secretary of Health. The study was based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
Among the 1,338 prehospital examinations performed, a total of 250 admissions in tertiary hospitals were registered. There was a significant agreement (p < 0.01) of 71% of the electrocardiographic changes identified in the prehospital setting with the diagnosis of ACS confirmed in the hospital setting. These changes were more prevalent in men (p = 0.048) and in patients aged 60 years or older (p = 0.006).
The tele-ECG allows the early diagnosis of ACS, reducing the delay to definitive treatment, be it reperfusion, chemical, or mechanical therapy.
Seventy-two percent of the prehospital diagnosis of ACS based on electrocardiographic changes was later confirmed in the hospital setting.
远程心电图（tele-ECG）是急性缺血性病变筛查的有力工具。
在院前环境中诊断急性冠状动脉综合征（ACS）与在医院环境中确诊之间相关性的证据不足。本研究比较了基于心电图改变（如 ST 段偏移）的院前环境中 ACS 的假定诊断与医院环境中确诊的诊断。
对 2013 年 9 月至 2014 年 8 月期间来自阿雷格里港一家著名公共医疗保健服务的紧急救护车服务的患者的病历进行回顾性、横断面分析。数据来自远程心电图记录和卫生部门数据库中可用的病历。该研究基于观察性研究的报告强度（STROBE）指南。
在进行的 1338 次院前检查中，共有 250 名患者被收入三级医院。院前环境中识别的心电图变化与医院环境中确诊的 ACS 诊断之间存在显著一致性（p<0.01），一致性为 71%。这些变化在男性（p=0.048）和 60 岁或以上的患者中更为常见（p=0.006）。
远程心电图可早期诊断 ACS，从而缩短明确治疗（再灌注、化学或机械治疗）的延迟。
基于心电图变化的院前 ACS 诊断中，有 72%在医院环境中得到了后续确认。
