Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia.
South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
Catheter Cardiovasc Interv. 2022 Sep;100(3):295-303. doi: 10.1002/ccd.30300. Epub 2022 Jun 29.
We examined the appropriateness of prehospital cardiac catheter laboratory activation (CCL-A) in ST-segment elevation myocardial infarction (STEMI) utilizing the University of Glasgow algorithm (UGA) and remote interventional cardiologist consultation.
The incremental benefit of prehospital electrocardiogram (PH-ECG) transmission on the diagnostic accuracy and appropriateness of CCL-A has been examined in a small number of studies with conflicting results.
We identified consecutive PH-ECG transmissions between June 2, 2010 and October 6, 2016. Blinded adjudication of ECGs, appropriateness of CCL-A, and index diagnoses were performed using the fourth universal definition of MI. The primary outcome was the appropriate CCL-A rate. Secondary outcomes included rates of false-positive CCL-A, inappropriate CCL-A, and inappropriate CCL nonactivation.
Among 1088 PH-ECG transmissions, there were 565 (52%) CCL-As and 523 (48%) CCL nonactivations. The appropriate CCL-A rate was 97% (550 of 565 CCL-As), of which 4.9% (n = 27) were false-positive. The inappropriate CCL-A rate was 2.7% (15 of 565 CCL-As) and the inappropriate CCL nonactivation rate was 3.6% (19 of 523 CCL nonactivations). Reasons for appropriate CCL nonactivation (n = 504) included nondiagnostic ST-segment elevation (n = 128, 25%), bundle branch block (n = 132, 26%), repolarization abnormality (n = 61, 12%), artefact (n = 72, 14%), no ischemic symptoms (n = 32, 6.3%), severe comorbidities (n = 26, 5.2%), transient ST-segment elevation (n = 20, 4.0%), and others.
PH-ECG interpretation utilizing UGA with interventional cardiologist consultation accurately identified STEMI with low rates of inappropriate and false-positive CCL-As, whereas using UGA alone would have almost doubled CCL-As. The benefits of cardiologist consultation were identifying "masquerading" STEMI and avoiding unnecessary CCL-As.
我们利用格拉斯哥大学算法（UGA）和远程介入心脏病专家咨询，检查了 ST 段抬高型心肌梗死（STEMI）患者的院前心脏导管实验室激活（CCL-A）的适宜性。
已有少数研究检查了院前心电图（PH-ECG）传输对 CCL-A 的诊断准确性和适宜性的附加益处，但结果存在冲突。
我们确定了 2010 年 6 月 2 日至 2016 年 10 月 6 日期间连续的 PH-ECG 传输。使用第四版心肌梗死通用定义进行心电图、CCL-A 适宜性和指数诊断的盲法评估。主要结局是适宜的 CCL-A 率。次要结局包括假阳性 CCL-A、不适当的 CCL-A 和不适当的 CCL 不激活率。
在 1088 次 PH-ECG 传输中，有 565 次（52%）进行了 CCL-A，523 次（48%）未进行 CCL-A。适宜的 CCL-A 率为 97%（550 例中的 565 例），其中 4.9%（n=27）为假阳性。不适当的 CCL-A 率为 2.7%（565 例中的 15 例），不适当的 CCL 不激活率为 3.6%（523 例中的 19 例）。适宜的 CCL 不激活的原因（n=504）包括无诊断性 ST 段抬高（n=128，25%）、束支传导阻滞（n=132，26%）、复极异常（n=61，12%）、伪影（n=72，14%）、无缺血症状（n=32，6.3%）、严重合并症（n=26，5.2%）、一过性 ST 段抬高（n=20，4.0%）和其他原因。
利用 UGA 结合介入心脏病专家咨询进行 PH-ECG 解读，可准确识别 STEMI，且不适当和假阳性 CCL-A 的发生率较低，而仅使用 UGA 则会使 CCL-A 的发生率增加近一倍。心脏病专家咨询的益处在于识别“伪装”的 STEMI 和避免不必要的 CCL-A。
