Key result
Pre-hospital TTECG teleconsultation is linked to ~60% lower in-hospital mortality in ACS with cardiogenic shock.
Why the study?
It was hypothesized that high-risk patients with ACS and cardiogenic shock might benefit from TTECG-based triage, leading authors to examine triage- and LV function-related predictors of in-hospital mortality.
Does TTECG-based consultation and triage reduce in-hospital mortality in patients with acute coronary syndrome complicated by cardiogenic shock?
Observational (n=287)
No
Does TTECG-based consultation and triage reduce in-hospital mortality in patients with acute coronary syndrome complicated by cardiogenic shock?
Pre-hospital triage with trans-telephonic ECG is associated with significantly lower in-hospital mortality among high-risk patients with ACS complicated by cardiogenic shock.
TTECG triage was associated with lower mortality in ACS shock; hypothesis-generating and requires prospective validation before practice change.
As demonstrated by earlier studies, pre-hospital triage with trans-telephonic electrocardiogram (TTECG) and direct referral for catheter therapy shows great value in the management of out-of-hospital chest pain emergencies. It does not only improve in-hospital mortality in ST-segment elevation myocardial infarction, but it has also been identified as an independent predictor of higher in-hospital survival rate. Since TTECG-facilitated triage shortens both transport time and percutaneous coronary intervention (PCI)-related procedural time intervals, it was hypothesized that even high-risk patients with acute coronary syndrome (ACS) and cardiogenic shock (CS) might also benefit from TTECG-based triage. Here, we decided to examine our database for new triage- and left ventricular (LV) function-related parameters that can influence in-hospital mortality in ACS complicated by CS. ACS patients were divided into two groups, namely, (1) hospital death patients (n = 77), and (2) hospital survivors (control, n = 210). Interestingly, TTECG-based consultation and triage of CS and ACS patients were confirmed as significant independent predictors of lower hospital mortality risk (odds ratio (OR) 0.40, confidence interval (CI) 0.21–0.76, p = 0.0049). Regarding LV function and blood chemistry, a good myocardial reperfusion after PCI (high area at risk (AAR) blush score/AAR LV segment number; OR 0.85, CI 0.78–0.98, p = 0.0178) and high glomerular filtration rate (GFR) value at the time of hospital admission (OR 0.97, CI 0.96–0.99, p = 0.0042) were the most crucial independent predictors of a decreased risk of in-hospital mortality in this model. At the same time, a prolonged time interval between symptom onset and hospital admission, successful resuscitation, and higher peak creatine kinase activity were the most important independent predictors for an increased risk of in-hospital mortality. In ACS patients with CS, (1) an early TTECG-based teleconsultation and triage, as well as (2) good myocardial perfusion after PCI and a high GFR value at the time of hospital admission, appear as major independent predictors of a lower in-hospital mortality rate.
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Szabó et al. (2021) conducted an observational in Acute coronary syndrome complicated by cardiogenic shock (n=287). Trans-telephonic electrocardiogram (TTECG)-based teleconsultation and triage vs. No TTECG-based triage was evaluated on In-hospital mortality (OR 0.40, 95% CI 0.21-0.76, p=0.0049). Pre-hospital TTECG-based teleconsultation and triage were significant independent predictors of lower in-hospital mortality risk (OR 0.40) in patients with acute coronary syndrome complicated by cardiogenic shock.
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