Transport decisions: acute coronary syndrome and high-risk electrocardiograms

Patients experiencing a high-risk non-ST-elevation myocardial infarction are likely to benefit from prehospital medical contact, transport to a percutaneous coronary intervention (PCI) centre and early definitive treatment. They may be provisionally diagnosed through the identification of a high-risk electrocardiogram (ECG). Advances in ECG interpretation have led to the identification of a cohort of at-risk patients whose treatment may previously have been delayed. Patients with certain ECG changes are considered high risk and may be experiencing coronary occlusions. Early PCI and direct transport to a PCI-capable hospital are associated with a reduction in mortality and morbidity; this is associated with a lower financial burden on the health service. Early paramedic identification of these high-risk ECGs and appropriate transport decision-making can positively influence patient outcomes. High-risk ECGs include those that are positive for the modified Smith-Sgarbossa criteria, DeWinter T waves, Wellens syndrome, posterior acute myocardial infarction and aVR elevation. Continued education is correlated with more accurate ECG interpretation.