Canto J G, Rogers W J, Bowlby L J, French W J, Pearce D J, Weaver W D
University of Alabama Medical Center, Birmingham 35223, USA.
J Am Coll Cardiol. 1997 Mar 1;29(3):498-505. doi: 10.1016/s0735-1097(96)00532-3.
This study sought to examine the management and subsequent outcomes of patients with a prehospital electrocardiogram (ECG) in a large, voluntary registry of myocardial infarction.
The prehospital ECG has been proposed as a means of rapidly identifying patients with acute myocardial infarction who might be eligible for reperfusion therapy.
The characteristics and outcomes of patients with a prehospital ECG were compared with those without a prehospital ECG in the National Registry of Myocardial Infarction 2 data base. Included in the analysis were those patients who presented to the hospital within 12 h of an acute myocardial infarction. Excluded were patients with an in-hospital infarction, transferred-in referrals and self-transported patients.
Prehospital ECGs were obtained in 3,768 (5%) of 66,995 National Registry of Myocardial Infarction 2 patients meeting study criteria. Median time from myocardial infarction symptom onset until hospital arrival was longer among those having a prehospital ECG (152 vs. 91 min, p < 0.001). However, once in the hospital, the prehospital ECG group experienced a shorter median time to the initiation of either thrombolysis (30 vs. 40 min, p < 0.001) or primary angioplasty (92 vs. 115 min, p < 0.001). The prehospital ECG group was more likely to receive thrombolytic therapy (43% vs. 37%, p < 0.001) and to undergo primary angioplasty (11% vs. 7%, p < 0.001). Also, the prehospital ECG group was more likely to undergo coronary arteriography (55% vs. 40%, p < 0.001), angioplasty (24% vs. 16%, p < 0.001) or bypass surgery (10% vs. 6%, p < 0.001). The in-hospital mortality rate was 8% in patients with a prehospital ECG and 12% in those without a prehospital ECG (p < 0.001). After adjusting for baseline covariates utilizing multiple logistic regression analysis, this mortality difference remained statistically significant (odds ratio 0.83, 95% confidence interval 0.71 to 0.96, p = 0.01).
The prehospital ECG is infrequently utilized for diagnosing myocardial infarction, and among patients with a prehospital ECG, is associated with a longer time from symptom onset to hospital arrival. Despite these shortcomings, the prehospital ECG is a test that may potentially influence the management of patients with acute myocardial infarction through wider, faster in-hospital utilization of reperfusion strategies and greater usage of invasive procedures, factors that may possibly reduce shortterm mortality. Efforts to implement the prehospital ECG more widely and more rapidly may be indicated.
本研究旨在探讨在一个大型的自愿性心肌梗死登记系统中，院前心电图（ECG）患者的管理情况及后续结局。
院前心电图已被提议作为一种快速识别可能适合再灌注治疗的急性心肌梗死患者的方法。
在国家心肌梗死登记2数据库中，将有院前心电图患者的特征和结局与无院前心电图患者进行比较。纳入分析的是那些在急性心肌梗死12小时内入院的患者。排除院内梗死患者、转入的转诊患者和自行转运患者。
在符合研究标准的66995例国家心肌梗死登记2患者中，3768例（5%）进行了院前心电图检查。有院前心电图患者从心肌梗死症状发作到入院的中位时间更长（152分钟对91分钟，p<0.001）。然而，一旦入院，院前心电图组开始溶栓治疗（30分钟对40分钟，p<0.001）或直接经皮冠状动脉腔内血管成形术（92分钟对115分钟，p<0.001）的中位时间更短。院前心电图组更有可能接受溶栓治疗（43%对37%，p<0.001）并接受直接经皮冠状动脉腔内血管成形术（11%对7%，p<0.001）。此外，院前心电图组更有可能接受冠状动脉造影（55%对40%，p<0.001）、血管成形术（24%对16%，p<0.001）或搭桥手术（10%对6%，p<0.001）。有院前心电图患者的院内死亡率为8%，无院前心电图患者为12%（p<0.001）。在利用多因素逻辑回归分析对基线协变量进行校正后，这种死亡率差异仍具有统计学意义（优势比0.83，95%置信区间0.71至0.96，p=0.01）。
院前心电图在诊断心肌梗死时很少被使用，并且在有院前心电图的患者中，从症状发作到入院的时间更长。尽管存在这些缺点，但院前心电图是一项可能通过在院内更广泛、更快地使用再灌注策略以及更多地使用侵入性手术来潜在影响急性心肌梗死患者管理的检查，这些因素可能会降低短期死亡率。可能需要做出努力以更广泛、更快速地应用院前心电图。
