PMID- 31931466
OWN - NLM
STAT- MEDLINE
DCOM- 20210621
LR  - 20210621
IS  - 1532-8430 (Electronic)
IS  - 0022-0736 (Linking)
VI  - 59
DP  - 2020 Mar-Apr
TI  - Derivation and validation of the Montreal prehospital ST-elevation myocardial 
      infarction activation rule.
PG  - 10-16
LID - S0022-0736(19)30746-0 [pii]
LID - 10.1016/j.jelectrocard.2019.12.013 [doi]
AB  - BACKGROUND: Prehospital ECGs (phECGs) are the main screening tool used by 
      paramedics to identify ST elevation myocardial infarction (STEMI). In the absence 
      of telemetry or personnel trained in ECG interpretation, paramedics must rely on 
      computerized interpretation of phECGs, which suffer from an elevated 
      false-positive (FP) rate, impairing reliable early activation of reperfusion 
      centers by Emergency Medical Services. OBJECTIVE: Develop a clinical prediction 
      rule to reduce the frequency of FPs for STEMI in prehospital patients. METHODS: 
      This was a retrospective analysis of prehospital patients with a computer 
      interpretation of '***ACUTE MI***' on phECG. We used logistic regression analysis 
      to identify the independent variables for derivation of the rule. Once derived, 
      we validated the rule on a distinct cohort of consecutive phECGs. RESULTS: Among 
      the 654 cases in the derivation cohort, 46.2% were FP STEMIs. Four elements 
      emerged as independent FP predictors: HR >/= 120, no ongoing chest pain, no 
      interpretable ST-segments in a lead, and presence of baseline wander or pacemaker 
      spikes. In the derivation cohort this rule decreased FPs to 15.1% of the total 
      cohort, while labelling 13.8% of STEMI cases as false-negatives (FNs). In the 
      validation cohort (386 phECGs, 41.7% FPs), the rule decreased FPs down to 8.0%, 
      while 25.9% were FN. CONCLUSION: Use of computer interpretation alone leads to a 
      high STEMI FP rate. A clinical prediction rule based upon four elements available 
      to paramedics can substantially lower the proportion of FPs. This clinical 
      prediction rule should be incorporated into the decision for prehospital 
      activation of the cardiac catheterization laboratory.
CI  - Copyright (c) 2020 Elsevier Inc. All rights reserved.
FAU - Segal, Eli
AU  - Segal E
AD  - Urgences-sante, 6700 Jarry Street East, Montreal, Quebec H1P 0A4, Canada; 
      Department of Prehospital Medicine, Sacre-Coeur Hospital, 5400 Boul Gouin O, 
      Montreal, Quebec H4J 1C5, Canada; Emergency Department, Jewish General Hospital, 
      3755 Chemin de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1E2, Canada; McGill 
      University, 845 Sherbrooke St W, Montreal, Quebec H3A 0G4, Canada. Electronic 
      address: eli.segal@mcgill.ca.
FAU - Ross, Dave
AU  - Ross D
AD  - Department of Prehospital Medicine, Sacre-Coeur Hospital, 5400 Boul Gouin O, 
      Montreal, Quebec H4J 1C5, Canada; Prehospital Medicine Regional Authority, CISSS 
      de la Monteregie-Centre, 3120 Boulevard Taschereau, 7e etage, Greenfield Park, 
      Quebec J4V 2H1, Canada; Advanced Care Paramedic Training Program, Universite de 
      Montreal, 2900 Edouard Montpetit Blvd, Montreal, Quebec H3T 1J4, Canada.
FAU - Proulx, Marie-Helene
AU  - Proulx MH
AD  - Intensive Care Unit, Centre hospitalier de l'Universite de Montreal, 1000, rue 
      Saint-Denis, Montreal, Quebec H2X 0C1, Canada.
FAU - Xue, Xiaoqing
AU  - Xue X
AD  - Emergency Department, Jewish General Hospital, 3755 Chemin de la 
      Cote-Sainte-Catherine, Montreal, Quebec H3T 1E2, Canada.
FAU - Vacon, Charlene
AU  - Vacon C
AD  - Regional Paramedic Program for Eastern Ontario, Ottawa Hospital, 2475 Don Reid 
      Dr, Ottawa, Ontario K1H 1E2, Canada.
LA  - eng
PT  - Journal Article
DEP - 20191226
PL  - United States
TA  - J Electrocardiol
JT  - Journal of electrocardiology
JID - 0153605
SB  - IM
MH  - Electrocardiography
MH  - *Emergency Medical Services
MH  - Humans
MH  - *Myocardial Infarction/diagnosis
MH  - Retrospective Studies
MH  - *ST Elevation Myocardial Infarction/diagnosis
OTO - NOTNLM
OT  - Electrocardiogram
OT  - Emergency medical services
OT  - ST elevation myocardial infarction
EDAT- 2020/01/14 06:00
MHDA- 2021/06/22 06:00
CRDT- 2020/01/14 06:00
PHST- 2019/10/18 00:00 [received]
PHST- 2019/11/19 00:00 [revised]
PHST- 2019/12/03 00:00 [accepted]
PHST- 2020/01/14 06:00 [pubmed]
PHST- 2021/06/22 06:00 [medline]
PHST- 2020/01/14 06:00 [entrez]
AID - S0022-0736(19)30746-0 [pii]
AID - 10.1016/j.jelectrocard.2019.12.013 [doi]
PST - ppublish
SO  - J Electrocardiol. 2020 Mar-Apr;59:10-16. doi: 10.1016/j.jelectrocard.2019.12.013. 
      Epub 2019 Dec 26.