Effect of prehospital 12-Lead electrocardiography on the emergent medical system for ST-Segment–Elevation myocardial infarction during the coronavirus disease 2019 (COVID-19) pandemic: results from the K-ACTIVE registry

Prehospital-electrocardiography (ECG) has been shown to be effective in reducing time to reperfusion in patients with myocardial infarction; however, its utility in disaster settings remains unclear.K-ACTIVE is a cardiovascular emergency registry comprising 58 hospitals in Kanagawa, Japan. 5,821 ST-segment–elevation myocardial infarction (STEMI) cases were enrolled during before-pandemic (January 2017 to December 2019; N = 3,946) and pandemic (January 2020 to November 2021; N = 1,875) (Cohort A). Additionally, 2,980 cases with complete time-course documentation from symptom onset to device insertion were analyzed (Cohort B). In Cohort A, the rates of primary percutaneous coronary intervention (PCI) and pre-hospital-ECG use were preserved during pandemic (94.1% vs. 95.4%, P = 0.206; and 47.8% vs. 45.0%, P = 0.054, respectively). In the analysis of Cohort B, all components of the time interval from symptom onset to device insertion were found to be significantly prolonged or showed a trend toward prolongation during pandemic. After propensity score matching based on age, sex, Killip classification, and history of MI, the time from emergency medical service (EMS) arrival to catheter laboratory entry was shorter in patients with prehospital ECG than in those without (62.0 (49.0–87.0) vs. 65.0 (53.0–85.0) minutes, P = 0.045). Moreover, this time interval did not change during pandemic in patients with prehospital-ECG (61.0 (49.0–86.0) vs. 64.0 (49.0–88.5) minutes, P = 0.33), whereas it was prolonged in patients without prehospital-ECG (64.0 (51.0–84.0) vs. 70.5 (57.0–90.0) minutes, P = 0.002)Prehospital-ECG enabled timely transfer to the catheterization laboratory even under disaster conditions.