Very Rapid Treatment of ST-Segment–Elevation Myocardial Infarction

P rehospital ECG (PH-ECG) has been identified as a strategy to help reduce door-to-balloon (D2B) time during emergency treatment with percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (STEMI). 1 National Registry of Myocardial Infarction data from 2000 -2002 suggest utilization rates of PH-ECG of Ͻ10%. 2 More recent analysis of data from the National Cardiovascular Data Registry-Acute Coronary Treatment and Intervention Outcomes Network Registry of Ͼ7000 patients with acute coronary syndrome transported by emergency medical services (EMS) during 2007 found PH-ECG utilization rates of 27.4%.3 Among this cohort, D2B times were significantly shorter than the cohort of patients without PH-ECG, and there was a trend toward lower in-hospital mortality.Systems of care that have incorporated PH-ECGs into a citywide or region-wide strategy have demonstrated a significant reduction in D2B times, usually by triaging patients in the prehospital setting, bypassing non-PCI-capable hospitals, and transporting patients directly to a designated STEMI receiving center (SRC) capable of providing primary PCI.4,5 Rapid and accurate interpretation of the PH-ECG is a critical step in the process of incorporating PH-ECG into systems of care for acute STEMI.Different models for interpretation of PH-ECGs have been described, including computer algorithm interpretation, wireless transmission to designated centers for physician interpretation, and direct paramedic interpretation.