Role of rapid 12-lead electrocardiogram in triage initiatives for ST-elevation myocardial infarction patients self-presenting in emergency departments. A systematic review and meta-analysis.

Abstract

Aim: To assess impact of triage initiatives for rapid 12-lead electrocardiogram acquisition on Door-To-ECG, Door-To-Balloon, length of stay, and in-hospital mortality for self-presenting emergency department patients with ST-elevation myocardial infarction.

Methods: This systematic review encompassed cohort studies, controlled trials, one-group pretest-post-test studies, interventional, observational, and randomized controlled trials assessing rapid acquisition of electrocardiograms for patients above 18 years experiencing symptoms of ST-elevation myocardial infarction in emergency departments. Data from seven databases underwent screening, extraction, and quality appraisals by two independent reviewers. Employing a random-effects model, meta-analyses were conducted for primary outcomes; Door-To-ECG, Door-To-Balloon, length of stay, and in-hospital mortality. Subgroup analyses and meta-regression were performed for meta-analyses with over 10 studies.

Results: This review included 25 studies with 19,475 ST-elevation myocardial infarction patients. All were cohort studies with acceptable evidence quality. Our findings revealed that enhanced triage initiatives for electrocardiograms related to significant reductions in Door-To-ECG (MD -6.45 minutes, P < 0.001) and Door-To-Balloon (MD -24.40 minutes, P < 0.001) times. More institutions met benchmarked goals for Door-To-ECG (MD 22.2%, P < 0.001) and Door-To-Balloon (MD 15.6%, P < 0.001) times. Improvements reported in length of stays and in-hospital mortality were not significant. Subgroup and meta-regression analyses revealed significant differences in Door-To-ECG times but not in Door-To-Balloon times.

Conclusion: Positive impacts of such initiatives on ST-elevation myocardial infarction patient outcomes offer institutions opportunities to improve triage processes and training. Future research should focus on extended follow-up and larger sample sizes for a comprehensive understanding of sustained impacts.

Registration: PROSPERO: CRD42023472392.