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Original article
Effects of prehospital 12-lead ECG on processes of care and mortality in acute coronary syndrome: a linked cohort study from the Myocardial Ischaemia National Audit Project
  1. Tom Quinn1,
  2. Sigurd Johnsen1,2,
  3. Chris P Gale3,4,
  4. Helen Snooks5,
  5. Scott McLean6,
  6. Malcolm Woollard1,
  7. Clive Weston5,
  8. On behalf of the Myocardial Ischaemia National Audit Project (MINAP) Steering Group
  1. 1Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
  2. 2Surrey Clinical Research Centre, University of Surrey, Guildford, UK
  3. 3Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
  4. 4Department of Cardiology, York Teaching Hospital NHS Foundation Trust, York, UK
  5. 5College of Medicine, Swansea University, Swansea, UK
  6. 6NHS Fife, Kirkcaldy, Fife, UK
  1. Correspondence to Professor Tom Quinn, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK; t.quinn{at}


Objective To describe patterns of prehospital ECG (PHECG) use and determine its association with processes and outcomes of care in patients with ST-elevation myocardial infarction (STEMI) and non-STEMI.

Methods Population-based linked cohort study of a national myocardial infarction registry.

Results 288 990 patients were admitted to hospitals via emergency medical services (EMS) between 1 January 2005 and 31 December 2009. PHECG use increased overall (51% vs 64%, adjusted OR (aOR) 2.17, 95% CI 2.12 to 2.22), and in STEMI (64% vs 79%, aOR 2.34, 95% CI 2.25 to 2.44). Patients who received PHECG were younger (71 years vs 74 years, P<0.0001); and less likely to be female (33.1% vs 40.3%, OR 0.87, 95% CI 0.86 to 0.89), or to have comorbidities than those who did not. For STEMI, reperfusion was more frequent in those having PHECG (83.5% vs 74.4%, p<0.0001). PHECG was associated with more primary percutaneous coronary intervention patients achieving call-to-balloon time <90 min (27.9% vs 21.4%, aOR 1.38, 95% CI 1.24 to 1.54) and more patients who received fibrinolytic therapy achieving door-to-needle time <30 min (90.6% vs 83.7%, aOR 2.13, 95% CI 1.91 to 2.38). Patients with PHECG exhibited significantly lower 30-day mortality rates than those who did not (7.4% vs 8.2%, aOR 0.94, 95% CI 0.91 to 0.96).

Conclusions Findings from this national MI registry demonstrate a survival advantage in STEMI and non-STEMI patients when PHECG was used.

  • pre-hospital care
  • emergency medicine
  • 12 lead ECG
  • quality of care and outcomes
  • acute coronary syndrome

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