Abstract：
BACKGROUND: The benefit of prehospital 12‑lead electrocardiogram (PH-ECG) performed by emergency medical service personnel at the site of first medical contact (FMC) in patients with ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock (CS-STEMI) remains unclear. This study aimed to investigate the effect of PH-ECG on door-to-device time in patients with CS-STEMI.
METHODS: This study enrolled CS-STEMI (Killip class IV) patients who were transferred directly to hospitals by ambulance (n = 517) from the Kanagawa Acute Cardiovascular Registry database. Patients were divided into PH-ECG (+) (n = 270) and PH-ECG (-) (n = 247) groups. Patients who experienced out-of-hospital cardiac arrest, who did not undergo emergent coronary intervention, or whose data were missing were excluded. Patient characteristics, FMC-to-door time, door-to-device time, and in-hospital mortality were compared between the groups.
RESULTS: The patient backgrounds of the PH-ECG (+) and PH-ECG (-) groups were comparable. The peak creatinine kinase level was greater in the PH-ECG (+) group than in the PH-ECG (-) group [2756 (1292-6009) IU/ml vs. 2270 (957-5258) IU/ml, p = 0.048]. The FMC-to-door time was similar between the two groups [25 (20-33) min vs. 27 (20-35) min, p = 0.530], while the door-to-device time was significantly shorter in the PH-ECG group [74 (52-103) min vs. 83 (62-111) min, p = 0.007]. In-hospital mortality did not differ between the two groups (18 % vs. 21 %, p = 0.405). Multivariable logistic regression analyses revealed that PH-ECG (+) was independently associated with a door-to-device time < 60 min [odds ratio (95 % confidence intervals): 1.88 (1.24-2.83), p = 0.003].
CONCLUSIONS: PH-ECG was significantly associated with shorter door-to-device times in patients with CS-STEMI. Further studies with larger populations and more defined protocols are required to evaluate the utility of PH-ECG in patients with CS-STEMI.
METHODS: This study enrolled CS-STEMI (Killip class IV) patients who were transferred directly to hospitals by ambulance (n = 517) from the Kanagawa Acute Cardiovascular Registry database. Patients were divided into PH-ECG (+) (n = 270) and PH-ECG (-) (n = 247) groups. Patients who experienced out-of-hospital cardiac arrest, who did not undergo emergent coronary intervention, or whose data were missing were excluded. Patient characteristics, FMC-to-door time, door-to-device time, and in-hospital mortality were compared between the groups.
RESULTS: The patient backgrounds of the PH-ECG (+) and PH-ECG (-) groups were comparable. The peak creatinine kinase level was greater in the PH-ECG (+) group than in the PH-ECG (-) group [2756 (1292-6009) IU/ml vs. 2270 (957-5258) IU/ml, p = 0.048]. The FMC-to-door time was similar between the two groups [25 (20-33) min vs. 27 (20-35) min, p = 0.530], while the door-to-device time was significantly shorter in the PH-ECG group [74 (52-103) min vs. 83 (62-111) min, p = 0.007]. In-hospital mortality did not differ between the two groups (18 % vs. 21 %, p = 0.405). Multivariable logistic regression analyses revealed that PH-ECG (+) was independently associated with a door-to-device time < 60 min [odds ratio (95 % confidence intervals): 1.88 (1.24-2.83), p = 0.003].
CONCLUSIONS: PH-ECG was significantly associated with shorter door-to-device times in patients with CS-STEMI. Further studies with larger populations and more defined protocols are required to evaluate the utility of PH-ECG in patients with CS-STEMI.
摘要：
背景：对于ST段抬高型心肌梗死（STEMI）伴心源性休克（CS-STEMI）患者，急诊医疗服务人员在首次医疗接触（FMC）现场进行院前12导联心电图（PH-ECG）的益处尚不清楚。本研究旨在探讨PH-ECG对CS-STEMI患者到设备门时间的影响。
方法：本研究纳入了神奈川急性心血管登记数据库中通过救护车（n=517）直接转移到医院的CS-STEMI（KillipIV级）患者。将患者分为PH-ECG(+)组(n=270)和PH-ECG(-)组(n=247)。发生院外心脏骤停的患者,没有接受紧急冠状动脉介入治疗的人，或其数据缺失被排除.患者特征,FMC到门的时间，门到设备的时间，并比较两组患者的院内死亡率.
结果：PH-ECG（+）和PH-ECG（-）组的患者背景具有可比性。PH-ECG(+)组肌酐激酶峰值水平高于PH-ECG(-)组[2756(1292-6009)IU/mlvs.2270(957-5258)IU/ml,p=0.048]。两组之间的FMC到门时间相似[25（20-33）minvs.27(20-35)分钟,p=0.530],而PH-ECG组的门到设备时间明显缩短[74（52-103）minvs.83(62-111)分钟,p=0.007]。两组的住院死亡率没有差异(18%vs.21%,p=0.405）。多变量逻辑回归分析显示，PH-ECG（+）与门到装置时间<60分钟[比值比（95%置信区间）：1.88（1.24-2.83）独立相关，p=0.003]。
结论：在CS-STEMI患者中，PH-ECG与较短的设备进入时间显著相关。需要对更多人群和更明确的方案进行进一步研究，以评估PH-ECG在CS-STEMI患者中的实用性。
方法：本研究纳入了神奈川急性心血管登记数据库中通过救护车（n=517）直接转移到医院的CS-STEMI（KillipIV级）患者。将患者分为PH-ECG(+)组(n=270)和PH-ECG(-)组(n=247)。发生院外心脏骤停的患者,没有接受紧急冠状动脉介入治疗的人，或其数据缺失被排除.患者特征,FMC到门的时间，门到设备的时间，并比较两组患者的院内死亡率.
结果：PH-ECG（+）和PH-ECG（-）组的患者背景具有可比性。PH-ECG(+)组肌酐激酶峰值水平高于PH-ECG(-)组[2756(1292-6009)IU/mlvs.2270(957-5258)IU/ml,p=0.048]。两组之间的FMC到门时间相似[25（20-33）minvs.27(20-35)分钟,p=0.530],而PH-ECG组的门到设备时间明显缩短[74（52-103）minvs.83(62-111)分钟,p=0.007]。两组的住院死亡率没有差异(18%vs.21%,p=0.405）。多变量逻辑回归分析显示，PH-ECG（+）与门到装置时间<60分钟[比值比（95%置信区间）：1.88（1.24-2.83）独立相关，p=0.003]。
结论：在CS-STEMI患者中，PH-ECG与较短的设备进入时间显著相关。需要对更多人群和更明确的方案进行进一步研究，以评估PH-ECG在CS-STEMI患者中的实用性。
