Unité de Coordination Clinique des Services Préhospitaliers d'Urgence (UCCSPU), 143 Rue Wolfe, Lévis, Québec G6V 3Z1, Canada; Centre de Recherche de l'Hôtel-Dieu de Lévis, 143 Rue Wolfe, Lévis, Québec G6V 3Z1, Canada.
Unité de Coordination Clinique des Services Préhospitaliers d'Urgence (UCCSPU), 143 Rue Wolfe, Lévis, Québec G6V 3Z1, Canada; Centre de Recherche de l'Hôtel-Dieu de Lévis, 143 Rue Wolfe, Lévis, Québec G6V 3Z1, Canada.
Am J Emerg Med. 2019 Jul;37(7):1242-1247. doi: 10.1016/j.ajem.2018.09.012. Epub 2018 Sep 6.
Prehospital 12‑lead electrocardiogram (ECG) is the most widely used screening tool for recognition of ST-segment elevation myocardial infarction (STEMI). However, prehospital diagnosis of STEMI based solely on ECGs can be challenging.
To evaluate the ability of emergency department (ED) physicians to accurately interpret prehospital 12‑lead ECGs from a remote location.
All suspected prehospital STEMI patients who were transported by EMS and underwent angiography between 2006 and 2014 were included. We reviewed prehospital ECGs and grouped them based on: 1) presence or absence of a culprit artery lesion following angiography; and 2) whether they met the 3rd Universal Definition of Myocardial Infarction. We also described characteristics of ECGs that were misinterpreted by ED physicians.
A total of 625 suspected STEMI cases were reviewed. Following angiography, 94% (590/625) of patients were found having a culprit artery lesion, while 6% (35/625) did not. Among these 35 patients, 24 had ECGs that mimicked STEMI criteria and 9 had non-ischemic signs. Upon ECG reinterpretation, 92% (577/625) had standard STEMI criteria while 8% (48/625) did not. Among these 48 patients, 35 had ischemic signs ECGs and 13 did not. Characteristics of misinterpreted ECGs included pericarditis, early repolarization, STE > 1 mm (1‑lead only), and negative T-wave.
Remote interpretation of prehospital 12‑lead ECGs by ED physicians was a useful diagnostic tool in this EMS system. Even if the rate of ECG misinterpretation is low, there is still room for ED physicians operating from a remote location to improve their ability to accurately diagnose STEMI patients.
院前 12 导联心电图（ECG）是识别 ST 段抬高型心肌梗死（STEMI）最广泛使用的筛查工具。然而，仅基于 ECG 对 STEMI 进行院前诊断具有挑战性。
评估远程位置的急诊科（ED）医生准确解读院前 12 导联 ECG 的能力。
纳入 2006 年至 2014 年间通过 EMS 转运并接受血管造影的所有疑似院前 STEMI 患者。我们回顾了院前 ECG，并根据以下标准对其进行分组：1）血管造影后是否存在罪犯动脉病变；2）是否符合心肌梗死第三次通用定义。我们还描述了 ED 医生误诊的 ECG 特征。
共回顾了 625 例疑似 STEMI 病例。血管造影后，94%（590/625）的患者存在罪犯动脉病变，而 6%（35/625）没有。在这 35 名患者中，24 名患者的 ECG 符合 STEMI 标准，9 名患者的 ECG 无缺血迹象。重新解读 ECG 后，92%（577/625）的患者符合标准 STEMI 标准，而 8%（48/625）的患者不符合标准。在这 48 名患者中，35 名患者的 ECG 有缺血迹象，13 名患者的 ECG 无缺血迹象。误诊 ECG 的特征包括心包炎、早期复极、STE>1mm（仅 1 导联）和负 T 波。
ED 医生远程解读院前 12 导联 ECG 是该 EMS 系统中有用的诊断工具。即使 ECG 误诊率较低，但远程工作的 ED 医生仍有提高准确诊断 STEMI 患者能力的空间。
