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Feasibility of prehospital identification of non-ST-elevation myocardial infarction by ECG, troponin and echocardiography
BACKGROUND: Prehospital identification and selection of treatment strategy in patients with suspected non-ST-elevation myocardial infarction (NSTEMI) is challenging. The aim of this study was to evaluate the feasibility and diagnostic accuracy of prehospital ECG, troponin T (TnT) and transthoracic e...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9411895/ https://www.ncbi.nlm.nih.gov/pubmed/35064012 http://dx.doi.org/10.1136/emermed-2021-211179 |
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author | Jacobsen, Lars Grenne, Bjørnar Olsen, Roy Bjørkholt Jortveit, Jarle |
author_facet | Jacobsen, Lars Grenne, Bjørnar Olsen, Roy Bjørkholt Jortveit, Jarle |
author_sort | Jacobsen, Lars |
collection | PubMed |
description | BACKGROUND: Prehospital identification and selection of treatment strategy in patients with suspected non-ST-elevation myocardial infarction (NSTEMI) is challenging. The aim of this study was to evaluate the feasibility and diagnostic accuracy of prehospital ECG, troponin T (TnT) and transthoracic echocardiography (TTE) acquired by paramedics in early identification of NSTEMI. METHODS: Consecutive patients requesting an ambulance from Sorlandet Hospital, Norway due to chest pain between November 2017 and January 2020 were screened for inclusion in the study. One ambulance was equipped with ECG recorder, point-of-care TnT test and TTE scanner, and six paramedics were given necessary training. ECG, TnT result and TTE images were acquired prehospitally and transferred to an in-hospital cardiologist. NSTEMI was suspected in patients with ischaemic ECG changes, elevated TnT or myocardial regional wall motion abnormalities (RWMA) at TTE. RESULTS: A total of 253 patients were included in the study. ECG was interpretable by cardiologists in 243 (96%), TnT in 238 (94%) and TTE images in 240 (95%) patients. NSTEMI was the discharge diagnosis in 22 (9%) of these patients. Four (18%) patients with NSTEMI had ischaemic ECG changes, elevated TnT and RWMA at TTE. Eight (36%) patients with NSTEMI had positive findings at two of the diagnostic methods, six (27%) patients had positive findings at one, and four (18%) patients had no positive findings in any of the diagnostic methods. In three patients (14%) with NSTEMI, RWMA was the only positive test. The negative and positive predictive values for RWMA were 42% and 96%, respectively. CONCLUSIONS: Prehospital acquisition of ECG, TnT and interpretable TTE images by paramedics were feasible in most patients with chest pain. Based on these examinations, it was possible to identify the majority of cases with NSTEMI prehospitally and admit the patients directly to a hospital with facilities for percutaneous coronary intervention (PCI) for further treatment. TRIAL REGISTRATION NUMBER: NCT04223986. |
format | Online Article Text |
id | pubmed-9411895 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-94118952022-09-12 Feasibility of prehospital identification of non-ST-elevation myocardial infarction by ECG, troponin and echocardiography Jacobsen, Lars Grenne, Bjørnar Olsen, Roy Bjørkholt Jortveit, Jarle Emerg Med J Original Research BACKGROUND: Prehospital identification and selection of treatment strategy in patients with suspected non-ST-elevation myocardial infarction (NSTEMI) is challenging. The aim of this study was to evaluate the feasibility and diagnostic accuracy of prehospital ECG, troponin T (TnT) and transthoracic echocardiography (TTE) acquired by paramedics in early identification of NSTEMI. METHODS: Consecutive patients requesting an ambulance from Sorlandet Hospital, Norway due to chest pain between November 2017 and January 2020 were screened for inclusion in the study. One ambulance was equipped with ECG recorder, point-of-care TnT test and TTE scanner, and six paramedics were given necessary training. ECG, TnT result and TTE images were acquired prehospitally and transferred to an in-hospital cardiologist. NSTEMI was suspected in patients with ischaemic ECG changes, elevated TnT or myocardial regional wall motion abnormalities (RWMA) at TTE. RESULTS: A total of 253 patients were included in the study. ECG was interpretable by cardiologists in 243 (96%), TnT in 238 (94%) and TTE images in 240 (95%) patients. NSTEMI was the discharge diagnosis in 22 (9%) of these patients. Four (18%) patients with NSTEMI had ischaemic ECG changes, elevated TnT and RWMA at TTE. Eight (36%) patients with NSTEMI had positive findings at two of the diagnostic methods, six (27%) patients had positive findings at one, and four (18%) patients had no positive findings in any of the diagnostic methods. In three patients (14%) with NSTEMI, RWMA was the only positive test. The negative and positive predictive values for RWMA were 42% and 96%, respectively. CONCLUSIONS: Prehospital acquisition of ECG, TnT and interpretable TTE images by paramedics were feasible in most patients with chest pain. Based on these examinations, it was possible to identify the majority of cases with NSTEMI prehospitally and admit the patients directly to a hospital with facilities for percutaneous coronary intervention (PCI) for further treatment. TRIAL REGISTRATION NUMBER: NCT04223986. BMJ Publishing Group 2022-09 2022-01-21 /pmc/articles/PMC9411895/ /pubmed/35064012 http://dx.doi.org/10.1136/emermed-2021-211179 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Original Research Jacobsen, Lars Grenne, Bjørnar Olsen, Roy Bjørkholt Jortveit, Jarle Feasibility of prehospital identification of non-ST-elevation myocardial infarction by ECG, troponin and echocardiography |
title | Feasibility of prehospital identification of non-ST-elevation myocardial infarction by ECG, troponin and echocardiography |
title_full | Feasibility of prehospital identification of non-ST-elevation myocardial infarction by ECG, troponin and echocardiography |
title_fullStr | Feasibility of prehospital identification of non-ST-elevation myocardial infarction by ECG, troponin and echocardiography |
title_full_unstemmed | Feasibility of prehospital identification of non-ST-elevation myocardial infarction by ECG, troponin and echocardiography |
title_short | Feasibility of prehospital identification of non-ST-elevation myocardial infarction by ECG, troponin and echocardiography |
title_sort | feasibility of prehospital identification of non-st-elevation myocardial infarction by ecg, troponin and echocardiography |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9411895/ https://www.ncbi.nlm.nih.gov/pubmed/35064012 http://dx.doi.org/10.1136/emermed-2021-211179 |
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