Improving use of prehospital 12-lead ECG for early identification and treatment of acute coronary syndrome and ST-elevation myocardial infarction

Circ Cardiovasc Qual Outcomes. 2010 May;3(3):316-23. doi: 10.1161/CIRCOUTCOMES.109.895045.


Background: Performance of prehospital ECGs expedites identification of ST-elevation myocardial infarction and reduces door-to-balloon times for patients receiving reperfusion therapy. To fully realize this benefit, emergency medical service performance must be measured and used in feedback reporting and quality improvement.

Methods and results: This quasi-experimental design trial tested an approach to improving emergency medical service prehospital ECGs using feedback reporting and quality improvement interventions in 2 cities' emergency medical service agencies and receiving hospitals. All patients age > or =30 years, calling 9-1-1 with possible acute coronary syndrome, were included. In total, 6994 patients were included: 1589 patients in the baseline period without feedback and 5405 in the intervention period when there were feedback reports and quality improvement interventions. Mean age was 66+/-17 years, and women represented 51%. Feedback and quality improvement increased prehospital ECG performance for patients with acute coronary syndrome from 76% to 93% (P=<0.0001) and for patients with ST-elevation myocardial infarction from 77% to 99% (P=<0.0001). Aspirin administration increased from 75% to 82% (P=0.001), but the median total emergency medical service run time remained the same at 22 minutes. The proportion of patients with door-to-balloon times of < or =90 minutes increased from 27% to 67% (P=0.006).

Conclusions: Feedback reports and quality improvement improved prehospital ECG performance for patients with acute coronary syndrome and ST-elevation myocardial infarction and increased aspirin administration without prehospital transport delays. Improvements in door-to-balloon times were also seen.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Coronary Syndrome / diagnosis*
  • Acute Coronary Syndrome / epidemiology
  • Acute Coronary Syndrome / therapy
  • Aged
  • Aged, 80 and over
  • Aspirin / therapeutic use
  • Early Diagnosis
  • Electrocardiography / statistics & numerical data*
  • Emergency Medical Services*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / therapy
  • Myocardial Reperfusion*
  • Practice Guidelines as Topic
  • Quality Assurance, Health Care


  • Aspirin