Key result
Prehospital Glasgow ECG algorithm with cardiologist consultation achieves ~97% appropriate cath lab activations.
Why the study?
Studies assessing the incremental benefit of prehospital ECG transmission on diagnostic accuracy and appropriateness of cardiac catheter laboratory activation in STEMI have yielded conflicting results.
Does prehospital ECG interpretation utilizing a computer algorithm combined with remote interventional cardiologist consultation improve the appropriateness of cardiac catheter laboratory activation in suspected STEMI?
Observational (n=1,088)
Blinded adjudication
Does prehospital ECG interpretation utilizing a computer algorithm combined with remote interventional cardiologist consultation improve the appropriateness of cardiac catheter laboratory activation in suspected STEMI?
Combining computer-based prehospital ECG interpretation with remote interventional cardiologist consultation accurately identifies STEMI and minimizes inappropriate cath lab activations compared to using the algorithm alone.
Supports combined prehospital ECG algorithm plus consultation for high appropriate CCL activation; leaves open need for randomized trials before practice change.
OBJECTIVES: We examined the appropriateness of prehospital cardiac catheter laboratory activation (CCL-A) in ST-segment elevation myocardial infarction (STEMI) utilizing the University of Glasgow algorithm (UGA) and remote interventional cardiologist consultation. BACKGROUND: The incremental benefit of prehospital electrocardiogram (PH-ECG) transmission on the diagnostic accuracy and appropriateness of CCL-A has been examined in a small number of studies with conflicting results. METHODS: We identified consecutive PH-ECG transmissions between June 2, 2010 and October 6, 2016. Blinded adjudication of ECGs, appropriateness of CCL-A, and index diagnoses were performed using the fourth universal definition of MI. The primary outcome was the appropriate CCL-A rate. Secondary outcomes included rates of false-positive CCL-A, inappropriate CCL-A, and inappropriate CCL nonactivation. RESULTS: Among 1088 PH-ECG transmissions, there were 565 (52%) CCL-As and 523 (48%) CCL nonactivations. The appropriate CCL-A rate was 97% (550 of 565 CCL-As), of which 4.9% (n = 27) were false-positive. The inappropriate CCL-A rate was 2.7% (15 of 565 CCL-As) and the inappropriate CCL nonactivation rate was 3.6% (19 of 523 CCL nonactivations). Reasons for appropriate CCL nonactivation (n = 504) included nondiagnostic ST-segment elevation (n = 128, 25%), bundle branch block (n = 132, 26%), repolarization abnormality (n = 61, 12%), artefact (n = 72, 14%), no ischemic symptoms (n = 32, 6.3%), severe comorbidities (n = 26, 5.2%), transient ST-segment elevation (n = 20, 4.0%), and others. CONCLUSIONS: PH-ECG interpretation utilizing UGA with interventional cardiologist consultation accurately identified STEMI with low rates of inappropriate and false-positive CCL-As, whereas using UGA alone would have almost doubled CCL-As. The benefits of cardiologist consultation were identifying "masquerading" STEMI and avoiding unnecessary CCL-As.
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Faour et al. (2022) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=1,088). Prehospital ECG interpretation utilizing University of Glasgow algorithm and remote interventional cardiologist consultation was evaluated on Appropriate cardiac catheter laboratory activation (CCL-A) rate. Prehospital ECG interpretation utilizing the University of Glasgow algorithm with interventional cardiologist consultation achieved a 97% appropriate cardiac catheter laboratory activation rate.
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