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Feasibility of prehospital identification of non-ST-elevation myocardial infarction by ECG, troponin and echocardiography
Emergency Medicine Journal ( IF 2.7 ) Pub Date : 2022-09-01 , DOI: 10.1136/emermed-2021-211179
Lars Jacobsen 1, 2 , Bjørnar Grenne 3, 4 , Roy Bjørkholt Olsen 2 , Jarle Jortveit 5
Affiliation  

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][1]. Data are available on reasonable request. The data that support the findings of this study are available on request from the corresponding author (JJ). The data are not publicly available due to state restrictions. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04223986&atom=%2Femermed%2F39%2F9%2F679.atom

中文翻译:

心电图、肌钙蛋白和超声心动图在院前鉴别非 ST 段抬高心肌梗死的可行性

背景 疑似非 ST 段抬高心肌梗死 (NSTEMI) 患者的院前识别和治疗策略选择具有挑战性。本研究的目的是评估医护人员获得的院前心电图、肌钙蛋白 T (TnT) 和经胸超声心动图 (TTE) 在早期识别 NSTEMI 中的可行性和诊断准确性。方法 筛选 2017 年 11 月至 2020 年 1 月期间因胸痛而要求挪威 Sorlandet 医院救护车的连续患者,以纳入研究。一辆救护车配备了心电图记录仪、即时 TnT 测试和 TTE 扫描仪,六名护理人员接受了必要的培训。心电图、TnT 结果和 TTE 图像在院前采集并转移给住院心脏病专家。在 TTE 出现缺血性心电图改变、TnT 升高或心肌局部室壁运动异常 (RWMA) 的患者中怀疑有 NSTEMI。结果共纳入253例患者。243 名 (96%) 的心脏病专家可解读心电图,238 名 (94%) 患者可解读 TnT,240 名 (95%) 患者可解读 TTE 图像。NSTEMI 是这些患者中 22 名 (9%) 的出院诊断。四名 (18%) NSTEMI 患者在 TTE 时出现缺血性心电图变化、TnT 和 RWMA 升高。八名 (36%) 的 NSTEMI 患者在两种诊断方法中有阳性结果,六名 (27%) 患者在一种诊断方法中有阳性结果,四名 (18%) 患者在任何一种诊断方法中都没有阳性结果。在三名 NSTEMI 患者 (14%) 中,RWMA 是唯一的阳性测试。RWMA 的阴性和阳性预测值分别为 42% 和 96%。结论 在大多数胸痛患者中,医护人员院前采集心电图、TnT 和可解释的 TTE 图像是可行的。根据这些检查,可以在院前识别出大多数 NSTEMI 病例,并将患者直接送往有经皮冠状动脉介入治疗 (PCI) 设施的医院接受进一步治疗。试用注册号 [NCT04223986][1]。可根据合理要求提供数据。支持本研究结果的数据可向通讯作者 (JJ) 索取。由于国家限制,这些数据不公开。[1]:/lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04223986&atom=%2Femermed%2F39%2F9%2F679.atom 在大多数胸痛患者中,医护人员的 TnT 和可解释的 TTE 图像是可行的。根据这些检查,可以在院前识别出大多数 NSTEMI 病例,并将患者直接送往有经皮冠状动脉介入治疗 (PCI) 设施的医院接受进一步治疗。试用注册号 [NCT04223986][1]。可根据合理要求提供数据。支持本研究结果的数据可向通讯作者 (JJ) 索取。由于国家限制,这些数据不公开。[1]:/lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04223986&atom=%2Femermed%2F39%2F9%2F679.atom 在大多数胸痛患者中,医护人员的 TnT 和可解释的 TTE 图像是可行的。根据这些检查,可以在院前识别出大多数 NSTEMI 病例,并将患者直接送往有经皮冠状动脉介入治疗 (PCI) 设施的医院接受进一步治疗。试用注册号 [NCT04223986][1]。可根据合理要求提供数据。支持本研究结果的数据可向通讯作者 (JJ) 索取。由于国家限制,这些数据不公开。[1]:/lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04223986&atom=%2Femermed%2F39%2F9%2F679.atom 可以在院前识别出大多数 NSTEMI 病例,并将患者直接送往拥有经皮冠状动脉介入治疗 (PCI) 设施的医院进行进一步治疗。试用注册号 [NCT04223986][1]。可根据合理要求提供数据。支持本研究结果的数据可向通讯作者 (JJ) 索取。由于国家限制,这些数据不公开。[1]:/lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04223986&atom=%2Femermed%2F39%2F9%2F679.atom 可以在院前识别出大多数 NSTEMI 病例,并将患者直接送往拥有经皮冠状动脉介入治疗 (PCI) 设施的医院进行进一步治疗。试用注册号 [NCT04223986][1]。可根据合理要求提供数据。支持本研究结果的数据可向通讯作者 (JJ) 索取。由于国家限制,这些数据不公开。[1]:/lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04223986&atom=%2Femermed%2F39%2F9%2F679.atom 支持本研究结果的数据可向通讯作者 (JJ) 索取。由于国家限制,这些数据不公开。[1]:/lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04223986&atom=%2Femermed%2F39%2F9%2F679.atom 支持本研究结果的数据可向通讯作者 (JJ) 索取。由于国家限制,这些数据不公开。[1]:/lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04223986&atom=%2Femermed%2F39%2F9%2F679.atom
更新日期:2022-08-23
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