Prehospital diagnosis of patients with acute myocardial infarction

Abstract

Primary percutaneous intervention (PPCI) is the preferred treatment in patients with ST elevation myocardial infarction (STEMI) if this can be performed in a timely manner. The 2012 ESC Guidelines on management of AMI in patients presenting with ST-segment elevation advice that PPCI should be performed within 120 min of first medical contact. Prehospital diagnosis of patients with STEMI is performed to save time and make PPCI available to the majority of patients. Although diagnosing patients with STEMI is usually easy, there are important pitfalls and patients with STEMI are missed on occasion. In addition, it is well know that patients without ST elevation may also have a high-risk cardiac condition. The 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation stress the importance of urgent CAG in patients with high-risk non ST-segment elevation myocardial infarction (NSTEMI). Unfortunately, these patients are difficult to diagnose in the acute phase and important time may be spend establishing the correct diagnosis. Prehospital biomarker measurement has emerged as a method to gain important additional information. We review the evidence on prehospital diagnosis of patients with STEMI and, In addition, we present the current knowledge on the new diagnostic methods that could have a future role in prehospital rule-in and rule-out of cardiac disease.

Feasibility of CardioSecur®, a Mobile 4-Electrode/22-Lead ECG Device, in the Prehospital Emergency Setting

“…Prehospital management of ACS patients remains challenging due to limited resources, logistical difficulties and urgency of risk stratification forcing time-critical decisions (2,8). This predicament is aggravated by lack of prehospital diagnostic tools to corroborate respective decisions (8).…”

“…However, prehospital diagnostic tools to properly assess patients with acute chest pain in general and ACS in particular are very limited. Generally, prehospital diagnostic algorithms for acute chest pain heavily rely on patient history, physical examination and subsequent clinical judgement of treating physicians (2,7,8). When ACS is suspected performing a 12-lead electrocardiogram (ECG) is the only recommended prehospital tool with instant and broad availability (2,9).…”

“…When ACS is suspected performing a 12-lead electrocardiogram (ECG) is the only recommended prehospital tool with instant and broad availability (2,9). These ECG recordings have paramount implications for risk stratification and treatment of ACS patients including timing of cardiac catheterization (2,8,10). Therefore, a conventional 12-lead electrocardiogram (c12L-ECG) serves as a critical pillar of prehospital triage and management of suspected ACS.…”

A Review on the Nonlinear Dynamical System Analysis of Electrocardiogram Signal

“…In the last few decades, the ECG signals have been widely analyzed for the diagnosis of the numerous cardiovascular diseases [ 1 , 2 ]. Apart from this, the ECG signals are processed to extract the RR intervals, which have been reported to divulge information about the influence of the autonomic nervous system activity on the heart through heart rate variability (HRV) analysis [ 3 , 4 ].…”

High-sensitivity assays for cardiac troponins – continued

“…However, if rapid rule-out strategies can be adopted at the point of care this may change profoundly the management of patients with suspected myocardial infarction reducing the number of patients admitted to a hospital emergency room or chest-pain unit. A recent article based on current evidence suggests that empowering practitioners to rapidly and reliably identify patients at low risk will also reduce health expenses for this patient group significantly [16,17].…”