Abstract
Background
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.
Methods
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.
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, 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%).
Conclusions
Use of pre-hospital ECG is associated with decreased mortality and overall better
patient outcomes.
Résumé
Introduction
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.
Méthodes
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.
Résultats
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 %).
Conclusions
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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Article info
Publication history
Published online: June 13, 2016
Accepted:
June 6,
2016
Received:
March 18,
2016
Footnotes
See page 1538 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
