Prehospital electrocardiograms (ECGs) do not improve the process of emergency department care in hospitals with higher usage of ECGs in non-ST-segment elevation myocardial infarction patients

Clin Cardiol. 2009 Dec;32(12):668-75. doi: 10.1002/clc.20673.


Background: This article will describe the impact of prehospital electrocardiogram (ECG) use on emergency department (ED) processes of care for non-ST-segment elevation myocardial infarction (NSTEMI) patients and assess the characteristics associated with prehospital ECG use.

Methods: This is a retrospective, multicenter, observational analysis of NSTEMI patients captured by the National Cardiovascular Data Registry-Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines (NCDR ACTION-GWTG) in 2007. Patient and hospital data were stratified by documentation of a prehospital ECG (pECG). Hospitals were stratified into tertiles of pECG use by higher pECG (>5.6%, n 91), lower pECG (< or = 5.6%, n = 83), or no pECG (n = 100). Statistical evaluation was done via Wilcoxon rank sum and chi(2) tests.

Results: There were 21 251 patients eligible for analysis. A pECG was documented in 1609 (7.6%) patients. Of 274 hospitals, 100 (36.5%) had no pECGs recorded. Median ED length of stay (LOS) was shorter at no pECG hospitals vs lower pECG hospitals (3.97 h vs 4.12 h, P < 0.05), but not higher pECG hospitals vs no pECG hospitals (3.85 h vs 3.97 h, P = not significant [NS]). A pECG was not associated with an improvement in ED performance metrics (use of aspirin, beta-blocker, any heparin) in the higher pECG hospitals vs no pECG hospitals or the lower pECG hospitals vs no pECG hospitals.

Conclusions: Use of prehospital ECG in NSTEMI patients is uncommon. In contrast to its impact on reperfusion times in ST-segment elevation myocardial infarction (STEMI) patients, its use does not appear to be associated with an improvement in ED processes of care at the hospital level.

Publication types

  • Multicenter Study

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Aged
  • Angioplasty, Balloon, Coronary
  • Anticoagulants / therapeutic use
  • Aspirin / therapeutic use
  • Cardiac Catheterization
  • Electrocardiography / statistics & numerical data*
  • Emergency Medical Services*
  • Emergency Service, Hospital*
  • Female
  • Heparin / therapeutic use
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Myocardial Infarction / therapy*
  • Platelet Aggregation Inhibitors / therapeutic use
  • Quality of Health Care
  • Registries
  • Retrospective Studies
  • United States


  • Adrenergic beta-Antagonists
  • Anticoagulants
  • Platelet Aggregation Inhibitors
  • Heparin
  • Aspirin