Pre-hospital ECG administration and clinical outcomes in ST-segment myocardial infarction: a systematic review and meta-analysis

Abstract Background Delays in reperfusion for patients with myocardial ischemia leads to increased morbidity and mortality. The objectives of this review was to identify, evaluate and critically-appraise the evidence on whether pre-hospital ECG reduces patient mortality and improves post-STEMI patie...

Full description

Saved in:
Bibliographic Details
Published in:Canadian journal of cardiology 2016
Main Authors: Ducas, Robin A., MD, Labos, Christopher, MD, Allen, David, MD, Golian, Mehrdad, MD, Jeyaraman, Maya, MD PhD, Lys, Justin, MD, Mann, Amrinder, MD, Copstein, Leslie, MD, Vokey, Sherri, MLIS, Rabbani, Rasheda, PhD, Zarychanski, Ryan, Msc MD, Abou-Setta, Ahmed M., MD PhD, Menkis, Alan H., MD
Format: Article
Language:English
Subjects:
Cardiovascular
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Background Delays in reperfusion for patients with myocardial ischemia leads to increased morbidity and mortality. The objectives of this review was to identify, evaluate and critically-appraise the evidence on whether pre-hospital ECG reduces patient mortality and improves post-STEMI patient-oriented outcomes. Methods We searched PubMed/MEDLINE, EMBASE and Cochrane Library (1990 to 2015) for controlled clinical studies. We also searched conference proceedings, trial registries and reference lists of narrative and systematic reviews. Two reviewers independently identified and extracted data from studies comparing pre-hospital ECG with standard of care in patients with suspected myocardial infarction undergoing primary percutaneous coronary intervention. Internal validity was assessed using the Newcastle-Ottawa scale. Results We screened 21,197 citations and included 63 unique studies (plus 22 companion publications). Most studies were of moderate quality. Pre-hospital ECG was associated with significantly fewer deaths (relative risk (RR) 0.68, 95% confidence intervals (CI) 0.63 to 0.74; 45 studies; 71,315 patients; I 2 0%), reduced time-to-reperfusion (MD -35.32 minutes, 95% CI -44.02 to -26.61; 26 studies; 27,524 patients; I 2 97%), shorter hospital stays (mean difference (MD) -0.63 days, 95% CI -1.05 to -0.20; 10 studies; 39,275 patients; I 2 39%), and more patients had first medical contact-to-device time less than 90 minutes than standard of care (RR 1.77, 95% CI 1.52 to 2.07; 11 studies; 20,991patients; I 2 93% ). Conclusions Use of pre-hospital ECG is associated with decreased mortality and overall better patient outcomes.
ISSN:0828-282X
1916-7075
DOI:10.1016/j.cjca.2016.06.004