院前数字心电图传输对 STEMI 患者血管重建延迟和死亡率的影响：系统回顾与元分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS CJC Open Pub Date : 2024-10-01 DOI:10.1016/j.cjco.2024.06.012

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引用次数: 0

摘要

背景院前向介入心脏病专家传输 12 导联心电图（ECG）已成为许多 ST 段抬高型心肌梗死（STEMI）网络的护理标准，但尚未得到普遍采用。在这篇系统性综述和荟萃分析中，我们评估了 STEMI 患者院前数字心电图传输对门诊到设备时间、首次医疗接触到设备时间和死亡率的影响。方法我们对 MEDLINE、Embase 和 CENTRAL（从开始到 2023 年 7 月 24 日）中的所有英文研究进行了系统性综述，比较了 STEMI 患者院前数字心电图传输与无心电图传输的效果。我们进行了随机效应荟萃分析。结果我们纳入了 17 项观察性研究，共计 4306 名患者。在使用院前数字心电图传输的患者中，门到设备的时间缩短了 33.3 分钟（95% 置信区间 [CIs] -50.5，-16.2 分钟；P < 0.001；I2 99%）。院前数字心电图传输也缩短了首次医疗接触到设备的时间（平均差异为-24.7分钟；95% 置信区间为-37.1，-12.3分钟；P < 0.001；I2 96%）。院前数字心电图传输与无院前数字心电图传输相比，死亡率降低了 47%（1322 例中的 117 例（8.9%） vs 1322 例中的 181 例（13.7%），几率比 0.53，95% CI 0.40，0.69；P < 0.001；I2 = 0%）。STEMI 网络应考虑这些发现，在其护理系统中倡导院前心电图传输。研究注册CRD42024509271 (PROSPERO)。

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Effect of Prehospital Digital Electrocardiogram Transmission on Revascularization Delays and Mortality in ST-Elevation Myocardial Infarction Patients: Systematic Review and Meta-Analysis

Background

Prehospital transmission of the 12-lead electrocardiogram (ECG) to the interventional cardiologist has become the standard of care in many ST-elevation myocardial infarction (STEMI) networks but has not been adopted universally. In this systematic review and meta-analysis, we assess the effect of prehospital digital ECG transmission in STEMI patients on door-to-device times, first medical contact-to-device times, and mortality.

Methods

We performed a systematic review of all English-language studies in MEDLINE, Embase, and CENTRAL (from inception to July 24, 2023), comparing the effect of prehospital digital ECG transmission to that of no ECG transmission in STEMI patients. We performed a random-effects meta-analysis.

Results

We included 17 observational studies totalling 4306 patients. Door-to-device times were reduced by 33.3 minutes in patients with prehospital digital ECG transmission (95% confidence intervals [CIs] -50.5, -16.2 minutes; P < 0.001; I² 99%). First-medical-contact-to-device time also was reduced with prehospital digital ECG transmission (mean difference, -24.7 minutes; 95% CI -37.1, -12.3 minutes; P < 0.001; I² 96%). Prehospital digital ECG transmissions was associated with a 47% reduction in mortality compared to no prehospital digital ECG transmission (117 of 1322 (8.9%) vs 181 of 1322 (13.7%), odds ratio 0.53, 95% CI 0.40, 0.69; P < 0.001; I² = 0%).

Conclusions

Prehospital ECG transmission in STEMI patients, coupled with a systems of care reduced door-to-device times, first-medical-contact-to-device times, and mortality. STEMI networks should consider these findings to advocate for prehospital ECG transmission within their systems of care.