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    • Benefit of Prehospital Electrocardiogram on Door-to-device Time in ST-segment Elevation Myocardial Infarction with Cardiogenic Shock: Data from the Kanagawa Acute Cardiovascular Registry

    Jin Kirigaya,Yasushi Matsuzawa,Toshiaki Ebina,Takeru Abe,Noriaki Iwahashi,Kazuki Fukui,Atsuo Maeda,Yoshihiro Akashi,Junya Ako,Yuji Ikari,Atsuo Namiki,Ichiro Michishita,Teruyasu Sugano,Kouichi Tamura,Kiyoshi Hibi,Kazuo Kimura,Hiroshi Suzuki

    Journal of Cardiology（2024）

    Division of Cardiology | Department of Cardiovascular Medicine | Integrated Center for Science and Humanities | Department of Cardiology | Department of Emergency and Disaster Medicine | Department of Medical Science and Cardiorenal Medicine

    Cited 0|Views5
    Abstract
    Background The benefit of prehospital 12‑lead electrocardiogram (PH-ECG) performed by emergency medical service personnel at the site of first medical contact (FMC) in patients with ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock (CS-STEMI) remains unclear. This study aimed to investigate the effect of PH-ECG on door-to-device time in patients with CS-STEMI. Methods This study enrolled CS-STEMI (Killip class IV) patients who were transferred directly to hospitals by ambulance (n = 517) from the Kanagawa Acute Cardiovascular Registry database. Patients were divided into PH-ECG (+) (n = 270) and PH-ECG (−) (n = 247) groups. Patients who experienced out-of-hospital cardiac arrest, who did not undergo emergent coronary intervention, or whose data were missing were excluded. Patient characteristics, FMC-to-door time, door-to-device time, and in-hospital mortality were compared between the groups. Results The patient backgrounds of the PH-ECG (+) and PH-ECG (−) groups were comparable. The peak creatinine kinase level was greater in the PH-ECG (+) group than in the PH-ECG (−) group [2756 (1292–6009) IU/ml vs. 2270 (957–5258) IU/ml, p = 0.048]. The FMC-to-door time was similar between the two groups [25 (20−33) min vs. 27 (20–35) min, p = 0.530], while the door-to-device time was significantly shorter in the PH-ECG group [74 (52–103) min vs. 83 (62–111) min, p = 0.007]. In-hospital mortality did not differ between the two groups (18 % vs. 21 %, p = 0.405). Multivariable logistic regression analyses revealed that PH-ECG (+) was independently associated with a door-to-device time < 60 min [odds ratio (95 % confidence intervals): 1.88 (1.24–2.83), p = 0.003]. Conclusions PH-ECG was significantly associated with shorter door-to-device times in patients with CS-STEMI. Further studies with larger populations and more defined protocols are required to evaluate the utility of PH-ECG in patients with CS-STEMI.
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    Prehospital electrocardiogram,Cardiogenic shock,Acute myocardial infarction,Emergency medical care
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    【要点】：研究揭示了院前12导联心电图（PH-ECG）能显著缩短ST段抬高型心肌梗死伴心源性休克患者的门到设备时间，但对住院死亡率无显著影响。
    

    【方法】：研究通过分析 Kanagawa 急性心血管注册数据库中直接由救护车转送至医院的 STEMI 伴心源性休克患者数据，将患者分为接受 PH-ECG 和未接受 PH-ECG 的两组，比较了两组患者的基线特征、从首次医疗接触到医院的门到设备时间和住院死亡率。
    

    【实验】：研究使用 Kanagawa 急性心血管注册数据库作为数据集，结果显示接受 PH-ECG 的患者门到设备时间显著缩短，住院死亡率在两组间无显著差异，通过多变量逻辑回归分析确认 PH-ECG 是门到设备时间小于60分钟的独立预测因子。