Anroedh S S, Kardys I, Akkerhuis K M, Biekart M, van der Hulst B, Deddens G J, Smits P, Gardien M, Dubois E, Zijlstra F, Boersma E
Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
Cardiovascular Research school COEUR, Erasmus MC, Rotterdam, The Netherlands.
Neth Heart J. 2018 Nov;26(11):562-571. doi: 10.1007/s12471-018-1187-0.
In pre-hospital settings handled by paramedics, identification of patients with myocardial infarction (MI) remains challenging when automated electrocardiogram (ECG) interpretation is inconclusive. We aimed to identify those patients and to get them on the right track to primary percutaneous coronary intervention (PCI).
In the Rotterdam-Rijnmond region, automated ECG devices on all ambulances were supplemented with a modem, enabling transmission of ECGs for online expert interpretation. The diagnostic protocol for acute chest pain was modified and monitored for 1 year. Patients with an ECG that met the criteria for ST-elevation myocardial infarction (STEMI) were immediately transported to a PCI hospital. ECGs that did not meet the STEMI criteria, but showed total ST deviation ≥800 µv were transmitted for online interpretation by the ECG expert. Online supervision was offered as a service if ECGs showed conduction disorders, or had an otherwise 'suspicious' pattern according to the ambulance paramedics. We enrolled 1,076 patients with acute ischaemic chest pain who did not meet the automated STEMI criteria. Their mean age was 63 years; 64% were men. After online consultation, 735 (68%) patients were directly transported to a PCI hospital for further treatment. PCI within 90 min was performed in 115 patients.
During a 1-year evaluation of the modified pre-hospital triage protocol for patients with acute ischaemic chest pain, over 100 acute MI patients with an initially inconclusive ECG received primary PCI within 90 min. Because of these results, we decided to continue the operation of the modified protocol.
在护理人员处理的院前环境中，当自动心电图（ECG）解读结果不明确时，识别心肌梗死（MI）患者仍然具有挑战性。我们旨在识别这些患者，并使他们走上接受直接经皮冠状动脉介入治疗（PCI）的正确轨道。
在鹿特丹-莱茵蒙德地区，所有救护车上的自动ECG设备都配备了调制解调器，可传输ECG进行在线专家解读。修改了急性胸痛的诊断方案并进行了1年的监测。符合ST段抬高型心肌梗死（STEMI）标准的ECG患者被立即送往PCI医院。不符合STEMI标准但总ST段偏移≥800µv的ECG被传输给ECG专家进行在线解读。如果ECG显示传导障碍或根据救护人员的判断有其他“可疑”模式，则提供在线监督服务。我们纳入了1076例不符合自动STEMI标准的急性缺血性胸痛患者。他们的平均年龄为63岁；64%为男性。经过在线会诊，735例（68%）患者被直接送往PCI医院进行进一步治疗。115例患者在90分钟内接受了PCI。
在对急性缺血性胸痛患者改良的院前分诊方案进行1年评估期间，超过100例最初ECG结果不明确的急性MI患者在90分钟内接受了直接PCI。基于这些结果，我们决定继续实施改良方案。
