Normal prehospital electrocardiography is linked to long-term survival in patients presenting to the emergency department with symptoms of acute coronary syndrome

- Prehospital electrocardiography (PH ECG) acquisition is becoming standard of care for patients who activate '911' with symptoms of acute coronary syndrome (ACS).
- We examine differences in short-term and long-term outcomes in patients with and without completely normal PH ECG findings in the prehospital setting. The absence of ST-T wave changes, arrhythmia, and any other ECG abnormalities constitutes a completely normal PH ECG.
- Patients with completely normal PH ECG findings have significantly less adverse hospital outcomes, length of stay, and long-term mortality than patients with any PH ECG abnormality.
- Normal PH ECG findings offer additional opportunity for early triage, risk stratification, and clinical decision-making in patients with ischemic symptoms.

Aims/methodsWe studied 735 patients who activated "911" for chest pain and/or anginal equivalent symptoms and received 12-lead ECG monitoring with specialized ischemia monitoring software in the ambulance. Prehospital electrocardiograms (PH ECG) were analyzed to determine the proportion of patients who present with completely normal PH ECG findings (absence of ischemia/infarction, arrhythmia, or any other abnormality) and to compare outcomes among patients with and without any PH ECG abnormality.ResultsOf 735 patients (mean age 70.5, 52.4% male), 68 (9.3%) patients had completely normal PH ECG findings. They experienced significantly less adverse hospital outcomes (12% vs 37%), length of stay (1.19 vs 3.86 days), and long-term mortality (9% vs 28%) than those with any PH ECG abnormality (p < .05).ConclusionNormal PH ECG findings are associated with better short and long-term outcomes in ambulance patients with ischemic symptoms. These findings may enhance early triage and risk stratification in emergency cardiac care.