{
  "abstract": "Importance/background The 12-lead ECG is recommended in clinical guidelines for prehospital assessment of patients with suspected acute coronary syndrome (ACS) presenting to Emergency Medical Services (EMS).Objectives To determine prehospital ECG (PHECG) utilisation since UK national rollout of primary percutaneous coronary intervention, and whether this is associated with clinical outcomes in patients with ACS.Design Population-based, linked cohort study using Myocardial Ischaemia National Audit Project data from 1 January 2010 to 31 December 2017, related to patients with ACS conveyed by the EMS to hospital in England and Wales.Exposure PHECG administration.Outcomes Proportion of patients where PHECG was recorded, 30-day and 1 year all-cause mortality, use of reperfusion.Results Of 330 713 eligible patients transferred by EMS, 263 420 patients (79.7%) had PHECG recorded, steadily increasing from 74.2% in 2010 to 85.0% in 2017. Patients who received PHECG were generally younger than those who did not (median age: 70 years vs 75 years), less likely to be female (32.8% vs 41.9%) or to have comorbidities such as diabetes (20.8% vs 24.7%) or peripheral vascular disease (4.1% vs 4.8%). Patients who received PHECG had lower mortality at 30 days (7.1% vs 10.9%), with adjusted OR 0.77 (95% CI 0.75 to 0.80), and at 1 year (14.2% vs 23.2%), with adjusted OR 0.69 (95% CI 0.68 to 0.71). Adjustment accommodated demographic characteristics, comorbidities and medical history. Reperfusion was more frequent in patients with ST-elevation myocardial infarction (STEMI) receiving PHECG (84.5% vs 54.7%) with adjusted OR 4.37 (95% CI 4.20 to 4.54), with similar adjustment.Conclusions Use of PHECG by EMS for patients with ACS is associated with lower short-term mortality and higher odds of receiving reperfusion for STEMI patients. Administration of PHECG increased steadily over time, but at the end of the study, still 15% of eligible patients did not receive a PHECG.",
  "authors": [
    {
      "affiliations": [
        "Swansea University Medical School, Swansea, UK"
      ],
      "name": "Timothy John Driscoll"
    },
    {
      "affiliations": [
        "South Western Ambulance Service NHS Foundation Trust, Exeter, UK"
      ],
      "name": "Sarah Black"
    },
    {
      "affiliations": [
        "Patient and Public Representative, London, UK"
      ],
      "name": "Glenn Davies"
    },
    {
      "affiliations": [
        "Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK"
      ],
      "name": "Chris P Gale"
    },
    {
      "affiliations": [
        "Kingston University, London, UK"
      ],
      "name": "Lucia Gavalova"
    },
    {
      "affiliations": [
        "Kingston University, London, UK"
      ],
      "name": "Mary Halter"
    },
    {
      "affiliations": [
        "Welsh Ambulance Services University NHS Trust, Cwmbran, UK"
      ],
      "name": "Chelsey Hughes"
    },
    {
      "affiliations": [
        "South East Coast Ambulance Service NHS Foundation Trust, Crawley, UK",
        "School of Health Sciences, University of Surrey, Guildford, UK"
      ],
      "name": "Scott Munro"
    },
    {
      "affiliations": [
        "Welsh Ambulance Services University NHS Trust, Cwmbran, UK"
      ],
      "name": "Nigel Rees"
    },
    {
      "affiliations": [
        "West Midlands Ambulance Service University NHS Foundation Trust, Brierley Hill, UK"
      ],
      "name": "Andy Rosser"
    },
    {
      "affiliations": [
        "Swansea University Medical School, Swansea, UK"
      ],
      "name": "Helen Snooks"
    },
    {
      "affiliations": [
        "Swansea University Medical School, Swansea, UK"
      ],
      "name": "Alan Watkins"
    },
    {
      "affiliations": [
        "Glangwili General Hospital, Carmarthen, UK"
      ],
      "name": "Clive Weston"
    },
    {
      "affiliations": [
        "Kingston University, London, UK"
      ],
      "name": "Tom Quinn"
    }
  ],
  "title": "Prehospital 12-lead ECG and outcomes in acute coronary syndrome",
  "uid": "21de2f55-f305-54e6-bea8-6ee1cf9904d8"
}