Rationale, development, and implementation of the Electrocardiographic Methods for the Prehospital Identification of Non-ST Elevation Myocardial Infarction Events (EMPIRE)
Rationale, development, and implementation of the Electrocardiographic Methods for the Prehospital Identification of Non-ST Elevation Myocardial Infarction Events (EMPIRE)
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DOI：
10.1016/j.jelectrocard.2015.08.014
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发表时间：
2015-11-01
影响因子：
1.3
通讯作者：
Callaway, Clifton
中科院分区：
文献类型：
--
作者：
Al-Zaiti, Salah S.;Martin-Gill, Christian;Callaway, Clifton
背景：心肌肌钙蛋白的血清升高仍然是诊断非st段抬高（NSTE）型心肌梗死（MI）的金标准，尽管它有延迟反应。实时检测NSTEMI的新方法将导致更直接地开始确定的医疗治疗，并更快地运送到可以提供专门心脏护理的设施。方法：EMPIRE是一项正在进行的前瞻性、观察性队列研究，旨在量化缺血诱导的复极化弥散程度，用于NSTEMI的早期检测。在这项正在进行的研究中，院前心电图数据收集自主诉为非创伤性胸痛的拨打911的患者。然后使用12导联心电图的主成分分析（PCA）技术对这些数据进行分析，以充分表征STT波形的空间和时间特征。结果：2013年5月至12月，匹兹堡EMS获取并传输了1149例送往参与医院的胸痛相关急诊患者的院前心电图351张。排除心电信号差（n = 40, 11%）、起搏或LBBB患者后。（n = 50, 14%），共有261例符合条件的患者（年龄57±16岁，45%女性，45%黑人）。在这个初步样本中，STEMI患者19例（7%），NSTEMI患者33例（12%）。超过50%的梗死患者（STEMI或NSTEMI）在就诊时肌钙蛋白值为阴性。我们提出了使用我们的方法正确识别的这种NSTEMI病例的心电图数据。结论：具体的ECG算法可以量化NSTE缺血，并允许根据这种ECG变化进行差异化治疗，可以对患者的临床结果产生直接影响。我们描述了EMPIRE研究的基本原理、开发、设计和潜在用途。这些发现可能会对指导方针的修订和改善公众健康产生影响。(C) 2015爱思唯尔公司版权所有。
Background: The serum rise of cardiac troponin remains the gold standard for diagnosing non-ST elevation (NSTE) myocardial infarction (MI) despite its delayed response. Novel methods for real-time detection of NSTEMI would result in more immediate initiation of definitive medical therapy and faster transport to facilities that can provide specialized cardiac care.Methods: EMPIRE is an ongoing prospective, observational cohort study designed to quantify the magnitude of ischemia-induced repolarization dispersion for the early detection of NSTEMI. In this ongoing study, prehospital ECG data is gathered from patients who call 9-1-1 with a chief complaint of non-traumatic chest pain. This data is then analyzed using the principal component analysis (PCA) technique of 12-lead ECGs to fully characterize the spatial and temporal qualities of STT waveforms.Results: Between May and December of 2013, Pittsburgh EMS obtained and transmitted 351 prehospital ECGs of the 1149 patients with chest pain-related emergency dispatches transported to participating hospitals. After excluding those with poor ECG signal (n = 40, 11%) and those with pacing or LBBB.(n = 50, 14%), there were 261 eligible patients (age 57 +/- 16 years, 45% female, 45% Black). In this preliminary sample, there were 19 STEMI (7%) and 33 NSTEMI (12%). More than 50% of those with infarction (STEMI or NSTEMI) had initially negative troponin values upon presentation. We present ECG data of such NSTEMI case that was identified correctly using our methods.Conclusions: Concrete ECG algorithms that can quantify NSTE ischemia and allow differential treatment based on such ECG changes could have an immediate clinical impact on patient outcomes. We describe the rationale, development, design, and potential usefulness of the EMPIRE study. The findings may provide insights that can influence guidelines revisions and improve public health. (C) 2015 Elsevier Inc. All rights reserved.