Canadian Journal of Cardiology
Systematic Review/Meta-analysis| Volume 32, ISSUE 12, P1531-1541, December 2016

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Association of Pre-hospital ECG Administration With Clinical Outcomes in ST-Segment Myocardial Infarction: A Systematic Review and Meta-analysis



      Delays in reperfusion for patients with myocardial ischemia leads to increased morbidity and mortality. The objective of this review was to identify, evaluate, and critically appraise the evidence on whether pre-hospital electrocardiography (ECG) reduces patient mortality and improves post—ST-segment myocardial infarction patient-oriented outcomes.


      We searched PubMed/MEDLINE, EMBASE, and Cochrane Library (1990-2015) 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 that compared pre-hospital ECG with standard of care in patients with suspected myocardial infarction who underwent primary percutaneous coronary intervention. Internal validity was assessed using the Newcastle-Ottawa scale.


      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, 0.68; 95% confidence interval [CI], 0.63-0.74; 45 studies; 71,315 patients; I2, 0%), reduced time to reperfusion (mean difference, −35.32 minutes; 95% CI, −44.02 to −26.61; 26 studies; 27,524 patients; I2, 97%), shorter hospital stays (mean difference, −0.63 days; 95% CI, −1.05 to −0.20; 10 studies; 39,275 patients; I2, 39%), and more patients had first medical contact to device time < 90 minutes than standard of care (relative risk, 1.77; 95% CI, 1.52-2.07; 11 studies; 20,991patients; I2, 93%).


      Use of pre-hospital ECG is associated with decreased mortality and overall better patient outcomes.



      Les retards de reperfusion chez les patients atteints d’une ischémie myocardique mènent à l’augmentation de la morbidité et de la mortalité. L’objectif de cette revue était de déterminer, d’évaluer et d’apprécier de manière critique les données probantes de manière à savoir si l’électrocardiographie (ECG) préhospitalier réduit la mortalité chez les patients et améliore les résultats cliniques axés sur le patient ayant subi un infarctus du myocarde avec sus-décalage du segment ST.


      Nous avons cherché des études comparatives dans PubMed/MEDLINE, EMBASE et la Bibliothèque Cochrane (1990-2015). Nous avons également cherché des procès-verbaux de conférences, des registres d’essais et des listes de référence de revues narratives et systématiques. Deux examinateurs ont indépendamment déterminé et extrait les données d’études qui comparaient l'ECG prehospitalier à la norme de soins des patients montrant une suspicion d’infarctus du myocarde qui subissaient une intervention coronarienne percutanée primaire. La validité interne était évaluée à l’aide de l’échelle Newcastle-Ottawa.


      Nous avons sélectionné 21 197 citations et inclus 63 études distinctes (et en plus 22 publications complémentaires). La plupart des études étaient de qualité modérée. L’ECG préhospitalier était associé à une diminution significative du nombre de décès (risque relatif, 0,68; intervalle de confiance [IC] à 95 %, 0,63-0,74; 45 études; 71 315 patients; I2, 0 %), à une réduction du temps de reperfusion (différence moyenne, −35,32 minutes; IC à 95 %, −44,02 à −26,61; 26 études; 27 524 patients; I2, 97 %), à des séjours à l’hôpital plus courts (différence moyenne, −0,63 jour; IC à 95 %, −1,05 à −0,20; 10 études; 39 275 patients; I2, 39 %), et un plus grand nombre de patients avaient un premier contact médical avant la mise en place du dispositif < 90 minutes comparativement à la norme de soins (risque relatif, 1,77; IC à 95 %, 1,52-2,07; 11 études; 20 991 patients; I2, 93 %).


      L’utilisation de l’ECG préhospitalier est associée à la diminution de la mortalité et à des résultats cliniques globalement meilleurs chez les patients.
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