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Association between use of pre-hospital ECG and 30-day mortality: A large cohort study of patients experiencing chest pain

Artikel i vetenskaplig tidskrift
Författare N. Rawshani
Araz Rawshani
C. Gelang
J. Herlitz
A. Bang
J. O. Andersson
M. Gellerstedt
Publicerad i International Journal of Cardiology
Volym 248
Sidor 77-81
ISSN 0167-5273
Publiceringsår 2017
Publicerad vid Institutionen för medicin
Sidor 77-81
Språk en
Länkar dx.doi.org/10.1016/j.ijcard.2017.06...
Ämnesord Pre-hospital, Chest pain, Electrocardiography (ECG), Mortality, acute myocardial-infarction, acute coronary syndrome, propensity score, thrombolytic therapy, intervention, outcomes, triage, Cardiovascular System & Cardiology
Ämneskategorier Kardiologi

Sammanfattning

Background: In the assessment of patients with chest pain, there is support for the use of pre-hospital ECG in the literature and in the care guidelines. Using propensity score methods, we aim to examine whether the mere acquisition of a pre-hospital ECG among patients with chest pain affects the outcome (30-day mortality). Methods: The association between pre-hospital ECG and 30-day mortality was studied in the overall cohort (n=13151), as well as in the one-to-one matched cohort with 2524 patients not examined with pre-hospital ECG and 2524 patients examined with pre-hospital ECG. Results: In the overall cohort, 21% (n=2809) did not undergo an ECG tracing in the pre-hospital setting. Among those who had pain during transport, 14% (n=1159) did not undergo a pre-hospital ECG while 32% (n=1135) of those who did not have pain underwent an ECG tracing. In the overall cohort, the OR for 30-day mortality in patients who had a pre-hospital ECG, as compared with those who did not, was 0.63 (95% CI 0.05-0.79; p < 0.001). In the matched cohort, the OR was 0.65 (95% CI 0.49-0.85; p < 0.001). Using the propensity score, in the overall cohort, the corresponding HR was 0.65 (95% CI 0.58-0.74). Conclusion: Using propensity score methods, we provide real-world data demonstrating that the adjusted risk of death was considerably lower among the cases in whoma pre-hospital ECG was used. The PH-ECG is underused among patients with chest discomfort and the mere acquisition of a pre-hospital ECG may reduce mortality. (C) 2017 Elsevier B.V. All rights reserved.

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