12-Lead ECG
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
1) Diagnostic accuracy 2)Time to thrombolytics
|
Process
|
PH-Paramedic
|
Ioannidis JPA., Salem D., Chew PW., Lau J. Accuracy & clinical effect of out-of-hospital electrography in the diagnosis of acute cardiac ischemia: A meta-analysis. Ann Emerg Med 2001; 37:461-70. Medline
|
|
I
|
Supportive (Green)
|
Prediction of in-hospital mortality
|
Process
|
ED-MD
|
Saw J, Davies C, Fung A, Spinelli JJ, Jue J. Value of ST elevation in lead III greater than lead II in inferior wall acute myocardial infarction for predicting in-hospital mortality and diagnosing right ventricular infarction. Am J Cardiol. 2001 Feb 15;87(4):448-50, A6. Medline
|
|
I
|
Supportive (Green)
|
Diagnostic accuracy
|
Process
|
PH-Paramedic
|
Tanaka A, Matsuo K, Kikuchi M, Kojima S, Hanada H, Mano T, et al. Systematic Review and Meta-Analysis of Diagnostic Accuracy to Identify ST-Segment Elevation Myocardial Infarction on Interpretations of Prehospital Electrocardiograms. Circ Rep 2022; 4(7):289–97. Medline
|
|
II
|
Supportive (Green)
|
Door to reperfusion time
|
Process
|
PH-Paramedic
|
Adams G., Abusaid G., Lee B., et al. From Theory to Practice: Implementation of pre-hospital electrocardiogram transmission in ST-elevation myocardial infarction - a multicenter experience. J Invasive Cardiol 2010; 22(11):520-5. Medline
|
|
II
|
Supportive (Green)
|
Door to reperfusion time
|
Process
|
PH-Paramedic
|
Adams GL., et al. Effectiveness of prehospital wireless transmission of ECGs to cardiologist via hand-held device for patients with AMI (from TIME-NE). Am J Cardiol 2006; 98:1160-4. Medline
|
|
II
|
Supportive (Green)
|
Door to Balloon Time
|
Process
|
PH-Paramedic
|
Afolabi BA., Novaro GM., Pinski SL., Fromkin KR., Bush HS. Use of the prehospital ECG improves door-to-balloon times in ST elevation MI irrespective of time or day or day of week. EMJ 2007; 24:588-91. Medline
|
|
II
|
Supportive (Green)
|
Use of prehospital 12 lead ECG in diagnosis of ACS
|
Process
|
PH-Paramedic & MD
|
Bouzid Z, Faramand Z, Martin-Gill C, et al. Incorporation of Serial 12-Lead Electrocardiogram With Machine Learning to Augment the Out-of-Hospital Diagnosis of Non-ST Elevation Acute Coronary Syndrome. Ann Emerg Med 2023; 81(1):57-69. Medline
|
|
II
|
Supportive (Green)
|
Reduction in time to reperfusion
|
Process
|
PH-Paramedic
|
Brainard AH., Raynovich W., Tandberg D., Bedrick EJ. The prehospital 12lead ECG effect on time to initiation of reperfusion therapy: A systematic review. Am J Emerg Med 2005; 23:351-6. Medline
|
|
II
|
Supportive (Green)
|
DTB time
|
Process
|
PH-Paramedic
|
Brown JP., Mahmud E., Dunford JV., Ben-Yehuda O. Effect of prehospital 12-lead ECG on activation of cardiac cath lab and door to balloon time in STEMI. Am J Cardiol 2008; 101:158-61. Medline
|
|
II
|
Supportive (Green)
|
Time to reperfusion
|
Process
|
PH-Paramedic
|
Brown SG., Galloway DM. Effect of ambulance 12-lead ECG recording on times to hospital reperfusion in acute myocardial infarction. Med J Aust 2000; 172(2):81-4. Medline
|
|
II
|
Supportive (Green)
|
Time to treatment
|
Process
|
|
Brunetti ND., De GL., Correale M., Santoro F., Caldarola P., Gaglione A., et al. Pre-hospital electrocardiogram triage with telemedicine near halves time to treatment in STEMI: A meta-analysis and meta-regression analysis of non-randomized studies. Int J Cardiol 2017; 232:5-11. Medline
|
|
II
|
Supportive (Green)
|
Positive STEMI interpretation
|
Process
|
|
Coffey C., Serra J., Goebel M., Espinoza S., Castillo E., Dunford J. Prehospital Acute ST-Elevation Myocardial Infarction Identification in San Diego: A Retrospective Analysis of the Effect of a New Software Algorithm. J Emerg Med 2018; 55(1):71-7. Medline
|
|
II
|
Supportive (Green)
|
Positive Predictive Value of paramedic interpretation
|
Process
|
PH-Paramedic
|
Davis DP., Graydon C., Stein R., et al. The positive predictive value of paramedic versus emergency physician interpretation of the prehospital 12-lead electrocardiogram. Prehosp Emerg Care 2007; 11(4):399-402. Medline
|
|
II
|
Supportive (Green)
|
Door to balloon time
|
Process
|
PH-Paramedic
|
deVilliers JS., et al. Expedited transfer for primary percutaneous coronary intervention: A program evaluation. CMAJ 2007; 176:1833. CMAJ
|
|
II
|
Supportive (Green)
|
Door to intervention time
|
Process
|
PH-Paramedic
|
Dhruva VN., et al. ST-segment analysis using wireless technology in AMI (STAT-MI) Trial. J Am Coll Cardiol 2007; 50:509-13. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
|
Ducas RA., Labos C., Allen D., Golian M., Jeyaraman M., Lys J., et al. Association of Pre-hospital ECG Administration With Clinical Outcomes in ST-Segment Myocardial Infarction: A Systematic Review and Meta-analysis. Can J Cardiol 2016; 32(12):1531-41. Medline
|
|
II
|
Supportive (Green)
|
Door to balloon time
|
Process
|
PH-Paramedic
|
Eckstein M., Cooper E., Nguyen T., Pratt FD. Impact of paramedic transport with prehospital 12lead ECG on door-to-balloon times for patients with STEMI. Prehosp Emerg Care 2009; 13:203-6. Medline
|
|
II
|
Supportive (Green)
|
Impaired left ventricular function
|
Patient
|
|
Fakhri Y., Ersba¸ll M., KA¸ber L., Hassager C., Hesselfeldt R., Steinmetz J., et al. Pre-hospital electrocardiographic severity and acuteness scores predict left ventricular function in patients with ST elevation myocardial infarction. J Electrocardiol 2016; 49(3):284-91. Medline
|
|
II
|
Supportive (Green)
|
cardiac catheter laboratory activation
|
Process
|
PH-Paramedic
|
Faour A, Cherrett C, Gibbs O, Lintern K, Mussap CJ, et al. Utility of prehospital electrocardiogram interpretation in ST-segment elevation myocardial infarction utilizing computer interpretation and transmission for interventional cardiologist consultation. Catheter Cardiovasc Interv 2022; 100(3):295–303. Medline
|
|
II
|
Supportive (Green)
|
Identification of AMI
|
Process
|
PH-Paramedic
|
Foster DB., Dufendach JH., Barkdoll CM. Prehospital recognition of AMI using independent nurse/paramedic 12-lead ECG evaluation: Impact on in-hospital times to thrombolysis in a rural community hospital. Am J Emerg Med 1994; 12:25-31. Medline
|
|
II
|
Supportive (Green)
|
Door to balloon time
|
Process
|
PH-Paramedic
|
Hutchison AW., Malaiapan Y., Cameron JD., Meredith IT. Pre-hospital 12 lead ECG to triage ST elevation myocardial infarction and long term improvements in door to balloon times: The first 1000 patients from the MonAMI project. Heart Lung Circ 2013; 22(11):910-6. Medline
|
|
II
|
Supportive (Green)
|
Time from FMC to reperfusion
|
Process
|
|
Kahlon TS., Barn K., Akram MM., Blankenship JC., Bower-Stout C., Carey DJ., et al. Impact of pre-hospital electrocardiograms on time to treatment and one year outcome in a rural regional ST-segment elevation myocardial infarction network. Catheterization and cardiovascular interventions: official journal of the Society for Cardiac Angiography & Interventions 2017; 89(2):245-51. Medline
|
|
II
|
Supportive (Green)
|
Door to needle time
|
Process
|
PH-Paramedic
|
Karagounis L., Ipsen SK., Jessop MR., et al. Impact of field-transmitted electrocardiography on time to in-hospital thrombolytic therapy in acute myocardial infarction. Am J Cardiol 1990; 66:786-91. Medline
|
|
II
|
Supportive (Green)
|
First medical contact to needle time
|
Process
|
PH-Paramedic
|
Kereiakes DJ., Gibler B., Martin LH., et al. Relative importance of emergency medical system transport and the prehospital electrocardiogram on reducing hospital time delay to therapy for acute myocardial infarction: Cincinnati. Am Heart J 1992; 123:835. Medline
|
|
II
|
Supportive (Green)
|
30-day all cause cardiac mortality
|
Patient
|
PH-Paramedic
|
Kohashi K, Nakano M, Isshiki T, et al. Clinical Efficacy of Pre-Hospital Electrocardiogram Transmission in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. Int Hear J July 2023; 64(4):535-42. Medline
|
|
II
|
Supportive (Green)
|
Resolution of ST segment elevation
|
Patient
|
PH-Paramedic
|
Kudenchuk PJ., Maynard C., Cobb LA., et al. Utility of the prehospital electrocardiogram in diagnosing acute coronary syndromes: The myocardial infarction triage and intervention (MITI) project. JACC 1998; 32(1):17-27. Medline
|
|
II
|
Supportive (Green)
|
Aborted MI
|
Process
|
PH-Paramedic
|
Lamfers EJ., Schut A., Hertzberger DP., et al. Prehospital versus hospital fibrinolytic therapy using automated versus cardiologist electrocardiographic diagnosis of myocardial infarction: Abortion of myocardial infarction and unjustified fibrinolytic therapy. Am Heart J. 2004; 147(3):509-515. Medline
|
|
II
|
Supportive (Green)
|
Meta-analysis aimed to investigate the impacts of prehospital telecardiology strategies on the clinical outcomes of rural ACS patients.
|
Process
|
PH-Paramedic & MD
|
Lazarus G, Kirchner HL, Siswanto BB. Prehospital tele-electrocardiographic triage improves the management of acute coronary syndrome in rural populations: A systematic review and meta-analysis. J Telemed Telecare 2020. Medline
|
|
II
|
Supportive (Green)
|
Safety and feasibility
|
Process
|
PH-Paramedic
|
Le May MR., Davies RF., Dionne R., et al. Comparison of early mortality of paramedic-diagnosed ST-segment elevation myocardial infarction with immediate transport to a designated primary percutaneous coronary intervention center to that of similar patients transported to the nearest hospital. Am J Cardiol 2006; 98(10):1329-1333. Medline
|
|
II
|
Supportive (Green)
|
Accuracy of STEMI detection
|
Process
|
PH-Paramedic
|
LeMay MR., et al. Diagnostic performance and potential clinical impact of ACP interpretation of STEMI in the field. CJEM 2006; 8(6):401-7. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Morrison LJ., Brooks S., Sawadsky B., McDonald A., Verbeek PR. Prehospital 12-lead electrocardiography impact on acute myocardial infarction treatment times and mortality: a systematic review. Acad Emerg Med 2006; 13(1):84-9. Medline
|
|
II
|
Supportive (Green)
|
Short-term mortality
|
Process
|
ED-MD
|
Nakashima T, Hashiba K, Kikuchi M, Yamaguchi J, Kojima S, Hanada H, Nonogi H. Impact of Prehospital 12-Lead Electrocardiography and Destination Hospital Notification on Mortality in Patients With Chest Pain - A Systematic Review. Circ Rep 2022; 4(5):187–93. Medline
|
|
II
|
Supportive (Green)
|
30 day mortality
|
Patient
|
PH-Paramedic
|
Nam J., Caners K., Bowen JM., Welsford M., O'Reilly D. Systematic review and meta-analysis of the benefits of out-of-hospital 12-lead ECG and advance notification in ST-segment elevation myocardial infarction patients. Ann Emerg Med 2014; 64(2):176-86. Medline
|
|
II
|
Supportive (Green)
|
Door to Balloon time
|
Process
|
PH-Paramedic
|
Ong ME., Wong AS., Seet CM., et al. Nationwide improvement of door-to-balloon times in patients with acute ST-segment elevation myocardial infarction requiring primary percutaneous coronary intervention with out-of-hospital 12-lead ECG recording and transmission. Ann Emerg Med 2013; 61(3):339-47. Medline
|
|
II
|
Supportive (Green)
|
Recognition of STEMI
|
Process
|
|
Pilbery R., Teare MD., Goodacre S., Morris F. The Recognition of STEMI by Paramedics and the Effect of Computer inTerpretation (RESPECT): a randomised crossover feasibility study. Emergency medicine journal: EMJ 2016; 33(7):471-6. Medline
|
|
II
|
Supportive (Green)
|
Process measures and 30 day mortality
|
Patient
|
PH-Paramedic
|
Quinn T., Johnsen S., Gale CP., et al. Effects of prehospital 12-lead ECG on processes of care and mortality in acute coronary syndrome: A linked cohort study from the myocardial ischaemia national audit project. Heart 2014; 100(12):944-50. Medline
|
|
II
|
Supportive (Green)
|
door-to-needles times
|
Process
|
PH-Paramedic
|
Rao A., Cardough Y., Darda S., Desai D., et al. Impact of the Prehospital ECH on Door-to-Balloon Time in ST-Elevation Myocardial Infarction. Cath Cardio Interv 2009; 75(2)174-8. Medline
|
|
II
|
Supportive (Green)
|
30 day mortality
|
Patient
|
|
Rawshani N., Rawshani A., Gelang C., Herlitz J., BÃ¥ng A., Andersson JO., et al. Association between use of pre-hospital ECG and 30-day mortality: A large cohort study of patients experiencing chest pain. Int J Cardiol 2017; 248:77-81. Medline
|
|
II
|
Supportive (Green)
|
Door to balloon time
|
Process
|
PH-Paramedic
|
Rokos IC., French WJ., Koenig WJ., et al. Integration of pre-hospital electrocardiograms and ST-elevation myocardial infarction receiving center (SRC) networks: Impact on door-to-balloon times across 10 independent regions. JACC Cardiovasc Interv 2009; 2(4):339-46. Medline
|
|
II
|
Supportive (Green)
|
Time to treatment
|
Process
|
PH-Paramedic
|
Sejersten M., et al. Effect on treatment delay of prehospital teletransmission of 12-lead ECG to a cardiologist for immediate triage and direct referral… Am J Cardiol 2008; 101:941-6. Medline
|
|
II
|
Supportive (Green)
|
Door to balloon time
|
Process
|
PH-Paramedic
|
Strauss DG., et al. Paramedic transtelephonic communication to cardiologist of clinical and electrographic assessment for rapid reperfusion of STEMI. J Electrocardiology 2007; 40:265-70. Medline
|
|
II
|
Supportive (Green)
|
Infarct Diagnosis
|
Patient
|
PH-Paramedic
|
van 't Hof AW., Rasoul S., van de Wetering H., et al. Feasibility and benefit of prehospital diagnosis, triage, and therapy by paramedics only in patients who are candidates for primary angioplasty for acute myocardial infarction. Am Heart J 2006; 151(6):1255.e1-1255.e5. Medline
|
|
II
|
Neutral (Yellow)
|
ED performance metric (ASA, B-blocker, heparin use in the ED)
|
Process
|
ED-MD
|
Cudnik MT., Frank Peacock W., Diercks DB., Roe MT., Chen AY. 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; 32(12):668-75. Medline
|
|
III
|
Supportive (Green)
|
Sensitivity, specificity and accuracy
|
Process
|
PH-Paramedic & MD
|
Almukhambetova E, Almukhambetov M, Musayev A, Yeshmanova A, Indershiyev V, Kalhodzhaeva Z. Remote Analysis and Transmission System of Electrocardiogram in Prehospital Setting; a Diagnostic Accuracy Study. Arch Acad Emerg Med 2022; 10(1):e5. Medline
|
|
III
|
Supportive (Green)
|
Sensitivity and specificity
|
Process
|
SIM
|
Alrumayh AA, Mubarak AM, Almazrua AA, Alharthi MZ, Alatef DF, Albacker TB, et al. Paramedic Ability in Interpreting Electrocardiogram with ST-segment Elevation Myocardial Infarction (STEMI) in Saudi Arabia. J Multidiscip Heal 2022;15:1657–65. Medline
|
|
III
|
Supportive (Green)
|
Utility
|
Process
|
PH-Paramedic
|
Aufderheide TP., Hendley GE., Thakur RK., et al. The diagnostic impact of prehospital 12-lead electrocardiography. Ann Emerg Med 1990; 19(11):1280-7. Medline
|
|
III
|
Supportive (Green)
|
Utility
|
Process
|
|
Aufderheide TP., Hendley GE., Woo J., et al. A prospective evaluation of prehospital 12-lead ECG application in chest pain patients. J of Electrocardiology (Supplement)1992; 24:8-13. Medline
|
|
III
|
Supportive (Green)
|
Quality of prehospital care of ACS
|
Process
|
|
Brokmann JC., Conrad C., Rossaint R., Bergrath S., Beckers SK., Tamm M., et al. Treatment of Acute Coronary Syndrome by Telemedically Supported Paramedics Compared With Physician-Based Treatment: A Prospective., Interventional., Multicenter Trial. Journal of medical Internet research 2016; 18(12):e314. Medline
|
|
III
|
Supportive (Green)
|
Number of STEMI in patients with atypical symptoms for AMI
|
Process
|
|
Campo Dell' OM., Hamm C., Liebetrau C., Hempel D., Merbs R., Cuca C., et al. Telemetry-assisted early detection of STEMI in patients with atypical symptoms by paramedic-performed 12-lead ECG with subsequent cardiological analysis. European journal of emergency medicine: official journal of the European Society for Emergency Medicine 2017; 24(4):272-6. Medline
|
|
III
|
Supportive (Green)
|
Identifying and MI
|
Patient
|
PH-Paramedic
|
Di Toro M, Stub D. Acute Myocardial Infarction Identified by Paramedics Using the Smith-Modified Sgarbossa Criteria: A Case Report. Prehosp Emerg Care 2021; 25(6):851–3. Medline
|
|
III
|
Supportive (Green)
|
Time to treatment
|
Process
|
PH-Paramedic
|
Diercks DB., Kontos MC., Chen AY., et al. Utilization and impact of pre-hospital electrocardiograms for patients with acute ST-segment elevation myocardial infarction: Data from the NCDR (national cardiovascular data registry) ACTION (acute coronary treatment and intervention outcomes network) registry. J Am Coll Cardiol 2009; 53(2):161-6. Medline
|
|
III
|
Supportive (Green)
|
Time to diagnosis and treatment
|
Process
|
PH-Paramedic
|
Drew BJ., Dempsey ED., Joo TH., et al. Pre-hospital synthesized 12-lead ECG ischemia monitoring with trans-telephonic transmission in acute coronary syndromes: Pilot study results of the ST SMART trial. J Electrocardiol 2004; 37(S):214-21. Medline
|
|
III
|
Supportive (Green)
|
Recognition
|
Process
|
PH-Paramedic
|
Funder J, Ross L, Ryan S. How effective are paramedics at interpreting ecgs in order to recognise stemi? A systematic review. Australasian J of ParaMed 2020; 17:1-9. Medline
|
|
III
|
Supportive (Green)
|
Diagnostic Quality ECG's
|
Process
|
|
Kotelnik V, Pesce K, Masterton WM, Marshall RT, Pigott G, Bialek N, et al. 12-Lead Electrocardiograms Acquired and Transmitted by Emerg Medical Technicians are of Diagnostic Quality and Positively Impact Patient Care. Prehosp Disaster Med 2020:1-4. Medline
|
|
III
|
Supportive (Green)
|
Feasibility
|
Process
|
PH-Paramedic
|
Kotelnik V, Pesce K, Masterton WM, Marshall RT, Pigott G, Bialek N, et al. 12-Lead Electrocardiograms Acquired and Transmitted by Emerg Medical Technicians are of Diagnostic Quality and Positively Impact Patient Care. Prehosp Disaster Med 2020:1-4. Medline
|
|
III
|
Supportive (Green)
|
Time to balloon
|
Process
|
PH-Paramedic
|
Report of the European Myocardial Infarction Project (EMIP) Sub-Committee. Potential time saving with pre-hospital intervention in acute myocardial infarction. Euro Heart J 1988; 9:118-24. Medline
|
|
III
|
Supportive (Green)
|
Rate of false positive
|
Process
|
|
Tanguay A., Brassard E., Lebon J., Bégin F., Hébert D., Paradis JM. Effectiveness of a Prehospital Wireless 12-Lead Electrocardiogram and Cardiac Catheterization Laboratory Activation for ST-Elevation Myocardial Infarction. Am J Cardiol 2017; 119(4):553-9. Medline
|
|
III
|
Supportive (Green)
|
Sensitivity and specificity
|
Process
|
SIM
|
Trivedi K., Schuur JD., Cone CD. Can paramedics read STEMI on prehospital 12-lead ECG? Prehosp Emerg Care 2009; 13:207-14. Medline
|
|
III
|
Neutral (Yellow)
|
Percent of EKGs with changes not on the ED EKG
|
Process
|
PH-Paramedic
|
Davis MT., Dukelow A., McLeod S., Rodriguez S., Lewell M. The utility of the prehospital electrocardiogram. CJEM 2011; 13(6):372-7. Medline
|
|
III
|
Neutral (Yellow)
|
Contact-to-balloon time
|
Process
|
PH-Paramedic
|
Martinoni A., De Servi S., Boschetti E., et al. Importance and limits of pre-hospital electrocardiogram in patients with ST elevation myocardial infarction undergoing percutaneous coronary angioplasty. Eur J Cardiovasc Prev Rehabil 2011; 18(3):526-32. Medline
|
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Lai JHY, Lui CT, Chan TWT, et al. Diagnostic accuracy of a prehospital electrocardiogram rule-based algorithm for ST-elevation myocardial infarction: results from a population-wide project. Hong Kong Med J. July 2024. Medline
|
Advanced Notice/Cath Lab Activation by EMS
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
II
|
Supportive (Green)
|
Door to reperfusion time
|
Process
|
PH-Paramedic
|
Adams G., Abusaid G., Lee B., et al. From Theory to Practice: Implementation of pre-hospital electrocardiogram transmission in ST-elevation myocardial infarction - a multicenter experience. J Invasive Cardiol 2010; 22(11):520-5. Medline
|
|
II
|
Supportive (Green)
|
major adverse cardiac events
|
Patient
|
PH-Paramedic
|
Blusztein D, Dinh D, Stub D, Dawson L, Brennan A, Reid C, et al. Predictors of hospital prenotification for STEMI and association of prenotification with outcomes. Emerg Med J 2021. Medline
|
|
II
|
Supportive (Green)
|
Time to PCI
|
Process
|
PH-Paramedic
|
Brunetti N., De Gennaro L., Correale M., Santoro F., et al. Pre-hospital electrocardiogram triage with telemedicine near halves time to treatment in STEMI: A meta-analysis and meta-regression analysis of non-randomized studies. Int J Cardio 2017; 232:5–11. Medline
|
|
II
|
Supportive (Green)
|
Symptom onset to balloon times
|
Process
|
PH-Paramedic
|
Carstensen S., et al. Field triage to primary angioplasty combined with emergency department bypass reduces treatment delays and is associated with improved outcome. Eur Heart J 2007; 28:2313-9. Medline
|
|
II
|
Supportive (Green)
|
Symptom to reperfusion, Mortality
|
Process
|
PH-Paramedic
|
Dalby M., Kharbanda R., Ghimire G., et al. Achieving routine sub 30 minute door-to-balloon times in a high volume 24/7 primary angioplasty center with autonomous ambulance diagnosis and immediate catheter laboratory access. Am Heart J 2009; 158(5):829-35. Medline
|
|
II
|
Supportive (Green)
|
Door-to-Balloon time
|
Process
|
Other
|
Evers JM, York NL, Owens H, Hardin-Pierce MG. Evaluation of Door-to-Balloon Times After Implementation of a ST-Segment Elevation Myocardial Infarction Network. J Cardiovasc Nurs 2022; 37(5):E107–13. Medline
|
|
II
|
Supportive (Green)
|
Symptom to balloon time
|
Process
|
PH-Paramedic
|
Hamilton GW, Yeoh J, Dinh D, Brennan A, Yudi MB, Freeman M, et al. Reperfusion times and outcomes in patients with ST-elevation myocardial infarction presenting without pre-hospital notification. Cardiovasc Revasc Med 2022. Medline
|
|
II
|
Supportive (Green)
|
30-day (short term) and > 6 month (long term) mortality
|
Patient
|
PH-Paramedic
|
Hashiba K, Nakashima T, Kikuchi M, Kojima S, Hanada H, Mano T, et al. Prehospital Activation of the Catheterization Laboratory Among Patients With Suspected ST-Elevation Myocardial Infarction Outside of a Hospital - Systematic Review and Meta-Analysis. Circ Rep 2022; 4(9):393–8. Medline
|
|
II
|
Supportive (Green)
|
30-day mortality from all-cause and cardiac death
|
Patient
|
PH-Paramedic
|
Kohashi K, Nakano M, Isshiki T, et al. Clinical Efficacy of Pre-Hospital Electrocardiogram Transmission in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. Int Hear J July 2023; 64(4):535-42. Medline
|
|
II
|
Supportive (Green)
|
Door to Balloon Time
|
Process
|
PH-Paramedic
|
Lazarus G, Kirchner HL, Siswanto BB. Prehospital tele-electrocardiographic triage improves the management of acute coronary syndrome in rural populations: A systematic review and meta-analysis. J Telemed Telecare 2020. Medline
|
|
II
|
Supportive (Green)
|
Door to balloon time
|
Process
|
PH-Paramedic
|
Le May MR., et al. A City-wide protocol for primary PCI in ST-segment elevation myocardial infarction. NEMJ 2008; 358:231-40. Medline
|
|
II
|
Supportive (Green)
|
Onset-to-device (OTD) time
|
Process
|
|
Mizuguchi Y., Shibutani H., Hashimoto S., Yamada T., Taniguchi N., Nakajima S., et al. Onset-to-device time of patients who arrive at off-hours: Importance of prehospital management and public awareness for patients with ST-segment elevation myocardial infarction. Cardiovascular therapeutics 2016; 34(6):475-81. Medline
|
|
II
|
Supportive (Green)
|
door-to-balloon time
|
Process
|
PH-Paramedic
|
Nelson BD, McLaughlin CJ, Rivera OE, et al. Implementation of a Novel Prehospital Clinical Decision Tool and ECG Transmission for STEMI Significantly Reduces Door-to-Balloon Time and Sex-Based Disparities. Prehosp Emerg Care May 2024; 1-10. Medline
|
|
II
|
Supportive (Green)
|
Rate of inappropriate activations
|
Process
|
|
Potter BJ., Matteau A., Mansour S., Naim C., Riahi M., Essiambre R., et al. Sustained Performance of a "Physicianless" System of Automated Prehospital STEMI Diagnosis and Catheterization Laboratory Activation. Can J Cardiol 2017; 33(1):148-54. Medline
|
|
II
|
Supportive (Green)
|
Composite endpoint (all cause mortality and recurrence of MI at 1 year)
|
Patient
|
|
Rigamonti F., Gencer B., Rey F., Chaara J., Tessitore E., Bunwaree S., et al. Pre-hospital alarm activation for STEMI patients undergoing primary percutaneous coronary intervention in the era of transradial procedures. Eur J Intern Med 2016; 35:83-8. Medline
|
|
II
|
Supportive (Green)
|
Door to balloon time
|
Process
|
PH-Paramedic
|
Savage ML, Hay K, Murdoch DJ, Doan T, Bosley E, Walters DL, Denman R, Ranasinghe I, Raffel OC. Clinical Outcomes in Pre-Hospital Activation and Direct Cardiac Catheterisation Laboratory Transfer of STEMI for Primary PCI. Hear Lung Circ 2022. Medline
|
|
II
|
Supportive (Green)
|
Door-to-Balloon Time
|
Patient
|
PH-Paramedic
|
Savage ML, Hay K, Murdoch DJ, Doan T, Bosley E, Walters DL, Denman R, Ranasinghe I, Raffel OC. Clinical Outcomes in Pre-Hospital Activation and Direct Cardiac Catheterisation Laboratory Transfer of STEMI for Primary PCI. Hear Lung Circ 2022. Medline
|
|
II
|
Supportive (Green)
|
Door to Balloon
|
Process
|
PH-Paramedic
|
Savage ML., Poon KK., Johnston EM., et al. Pre-hospital ambulance notification and initiation of treatment of ST elevation myocardial infarction is associated with significant reduction in door-to-balloon time for primary PCI. Heart Lung Circ 2014; 23(5):435-43. Medline
|
|
II
|
Supportive (Green)
|
First medical contact to balloon-time
|
Process
|
PH-Paramedic
|
Shoaib M, Huish W, Woollard EL, Aguila J, Coxall D, Alexander M, et al. Impact of Pre-Hospital Activation of STEMI on False Positive Activation Rate and Door to Balloon Time. Hear Lung Circ 2022; 31(3 447–455):447–55. Medline
|
|
II
|
Supportive (Green)
|
Feasibility
|
Process
|
PH-Paramedic
|
Sillesen M., et al. Referral of patients with STEMI directly to the cath suite based on prehospital teletransmission of 12 lead ECG. J Electrocardiography 2008; 41:49-53. Medline
|
|
II
|
Supportive (Green)
|
Mortality at one year post-PCI
|
Patient
|
|
Studnek JR., Infinger A., Wilson H., Niess G., Jackson P., Swanson D. Decreased Time from 9-1-1 Call to PCI among Patients Experiencing STEMI Results in a Decreased One Year Mortality. Prehospital emergency care: official journal of the National Association of EMS Physicians and the National Association of State EMS Directors 2018:1-7. Medline
|
|
II
|
Supportive (Green)
|
Treatment delay
|
Patient
|
PH-Paramedic
|
Terkelsen CJ., et al. Reduction of treatment delay in patients with STEMI: impact of prehospital diagnosis and direct referral to primary PCI. Eur Heart J 2005; 26:770-7. Medline
|
|
II
|
Neutral (Yellow)
|
Impact on prehospital scene time
|
Process
|
PH-Paramedic
|
Conrad D, Müller-Wirtz LM, Jakob S, Armbruster W, Volk MT, Berwanger U. Prehospital Electrocardiogram Transmission and Prehospital Scene Time: A Retrospective Cohort Study. Telemed J E Heal 2023. Medline
|
|
II
|
Neutral (Yellow)
|
False positive activations (computer interpretation)
|
Process
|
PH-Paramedic
|
Youngquist ST., Shah AP., Niemann JT., Kaji AH., French WJ. A comparison of door-to-balloon times and false-positive activations between emergency department and out-of-hospital activation of the coronary catheterization team. Acad Emerg Med 2008; 15(8):784-787. Medline
|
|
III
|
Supportive (Green)
|
Time to diagnosis and treatment
|
Process
|
PH-Paramedic
|
Drew BJ., Dempsey ED., Joo TH., et al. Pre-hospital synthesized 12-lead ECG ischemia monitoring with trans-telephonic transmission in acute coronary syndromes: Pilot study results of the ST SMART trial. J Electrocardiol 2004; 37(S):214-21. Medline
|
|
III
|
Supportive (Green)
|
Door to needle time
|
Process
|
PH-Paramedic
|
Goodacre S., Kelly AM., Kerr D. Potential impact of interventions to reduce times to thrombolysis. Emerg Med J 2004; 21(5):625-9. Medline
|
Anti-platelet (other)
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
Pre-PCI TIMI flow grade 2-3
|
Patient
|
PH-Paramedic
|
Chou YH, Huang CC, Chang CK, Huang JL, et al. The Coronary Reperfusion Effect and Safety of Prehospital P2Y12 Inhibitor in Primary-PCI STEMI Patients: A systematic review and Meta-analysis. Prehosp Emerg Care Nov 2023; 1-24. Medline
|
|
I
|
Supportive (Green)
|
All-cause mortality at 30-day, 1-year and 5-years.
|
Patient
|
|
Fabris E., Kilic S., Schellings DAAM., Ten BJ., Kennedy MW., van HK., et al. Long-term mortality and prehospital tirofiban treatment in patients with ST elevation myocardial infarction. Heart 2017; 103(19):1515-20. Medline
|
|
I
|
Supportive (Green)
|
ST elevation resolution
|
Patient
|
PH-Paramedic
|
Heestermans T., Suryapranata H., ten Berg JM., et al. Facilitated reperfusion with prehospital glycoprotein Iib/IIIa inhibition: Predictors of complete ST-segment resolution before primary percutaneous coronary intervention in the on-TIME 2 trial: Correlates of reperfusion before primary PCI. J Electrocardiol 2011; 44(1):42-48. Medline
|
|
I
|
Supportive (Green)
|
Acute stent thrombosis or 30-day ischemic outcomes after pPCI.
|
Patient
|
|
Huber K., Ducrocq G., Hamm CW., van 't HA., Lapostolle F., Coste P., et al. Early clinical outcomes as a function of use of newer oral P2Y12 inhibitors versus clopidogrel in the EUROMAX trial. Open heart 2017; 4(2):e000677. Medline
|
|
I
|
Supportive (Green)
|
Feasibility and safety
|
Process
|
PH-Paramedic
|
Pels K., Schroder J., Witzenbichler B., et al. Prehospital versus periprocedural abciximab in ST-elevation myocardial infarction treated by percutaneous coronary intervention. Eur J Emerg Med 2008; 15(6):324-9. Medline
|
|
I
|
Supportive (Green)
|
Infarct-related artery patency
|
Patient
|
ED-MD
|
Sabatine MS., et al. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med 2005; 352(12):1179-89. Medline
|
|
I
|
Supportive (Green)
|
Inhibition of platelet aggregation
|
Patient
|
PH-Paramedic
|
Smit JJ., van Werkum JW., ten Berg J., Slingerland R., Ottervanger JP., Heestermans T., et al. Prehospital triple antiplatelet therapy in patients with acute ST elevation myocardial infarction leads to better platelet aggregation inhibition and clinical outcome than dual antiplatelet therapy. Heart 2010; 96(22):1815-1820. Medline
|
|
I
|
Supportive (Green)
|
Clinical outcome at 30 days
|
Patient
|
PH-Paramedic
|
ten Berg JM., van ‘t Hof AW., Dill T., Heestermans T., et al. Effect of early, pre-hospital initiation of high bolus dose tirofiban in patients with ST-segment elevation myocardial infarction on short- and long-term clinical outcome. J Am Coll Cardiol 2010; 55(22)2446-55. Medline
|
|
I
|
Supportive (Green)
|
Clinical outcome at 30 days
|
Patient
|
PH-Paramedic
|
ten Berg JM., van 't Hof AW., Dill T., Heestermans T., van Werkum JW., Mosterd A., et al. Effect of early, pre-hospital initiation of high bolus dose tirofiban in patients with ST-segment elevation myocardial infarction on short- and long-term clinical outcome. J Am Coll Cardiol 2010; 55(22):2446-2455. Medline
|
|
I
|
Neutral (Yellow)
|
Infarct-related artery patency
|
Process
|
In-Patient
|
Dudek D., Rakowski T., Bartus S., Giszterowicz D., Dobrowolski W., Zmudka K., Zalewski J., Ochala A., Wieja P., Janus B., Dziewierz A., Legutko J., Bryniarski L., Dubiel J. Impact of early abciximab administration on myocardial reperfusion in patients with ST-segment elevation myocardial
infarction pretreated with 600 mg of clopidogrel before percutaneous coronary intervention. J Thromb Thrombolysis 2010; 30:347–53. Medline
|
|
I
|
Neutral (Yellow)
|
TIMI flow grade 2-3
|
Process
|
|
El Khoury C., Dubien PY., Mercier C., et al. Prehospital high-dose tirofiban in patients undergoing primary percutaneous intervention. The AGIR-2 study. Arch Cardiovasc Dis 2010; 103(5):285-92. Medline
|
|
I
|
Neutral (Yellow)
|
Mortality
|
Patient
|
PH-Paramedic
|
Gewehr DM, Carvalho PEP, Dagostin CS, et al. Pretreatment with P2Y12 inhibitors in ST-elevation myocardial infarction: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2023. Medline
|
|
I
|
Neutral (Yellow)
|
ST-segment resolution
|
Patient
|
PH-Paramedic
|
Montalescot G., van 't Hof AW., Lapostolle F., et al. Prehospital ticagrelor in ST-segment elevation myocardial infarction. N Engl J Med 2014; 371(11):1016-27. Medline
|
|
I
|
Neutral (Yellow)
|
Mortality
|
Patient
|
PH-Paramedic & CCT
|
Ohlmann P., Reydel P., Jacquemin L., et al. Prehospital abciximab in ST-segment elevation myocardial infarction: Results of the randomized, double-blind MISTRAL study. Circ Cardiovasc Interv 2012; 5(1):69-76, S1. Medline
|
|
I
|
Neutral (Yellow)
|
TIMI flow grade 0 or 1, death or recurrent MI pre-angiography
|
Patient
|
PH-Paramedic
|
Verheugt FW., Montalescot G., Sabatine MS., Soulat L., Lambert Y., Lapostolle F., et al. Prehospital fibrinolysis with dual antiplatelet therapy in ST-elevation acute myocardial infarction: a sub-study of the randomized double blind CLARITY-TIMI 28 trial. J Thromb Thrombolysis 2007; 23(3):173-179. Medline
|
|
I
|
Neutral (Yellow)
|
TIMI 3 flow
|
Patient
|
PH-Paramedic & MD
|
Vlachojannis GJ, Wilschut JM, Vogel RF, Lemmert ME, Delewi R, Diletti R, et al. Effect of Prehospital Crushed Prasugrel Tablets in Patients With ST-Segment-Elevation Myocardial Infarction Planned for Primary Percutaneous Coronary Intervention: The Randomized COMPARE CRUSH Trial. Circulation 2020; 142(24):2316-28. Medline
|
|
I
|
Neutral (Yellow)
|
TIMI grade 2/3 flow at angiography
|
Process
|
PH-Paramedic
|
Zeymer U., Arntz HR., Mark B., Fichtlscherer S., Werner G., Scholler R., et al. Efficacy and safety of a high loading dose of clopidogrel administered prehospitally to improve primary percutaneous coronary intervention in acute myocardial infarction: the randomized CIPAMI trial. Clin Res Cardiol 2012; 101(4):305-312. Medline
|
|
II
|
Supportive (Green)
|
TIMI flow
|
Process
|
ED-Paramedic & MD
|
Fabris E, Menzio S, Gregorio C, Pezzato A, Stolfo D, Aleksova A, et al. Effect of prehospital treatment in STEMI patients undergoing primary PCI. Catheter Cardiovasc Interv 2022. Medline
|
|
II
|
Supportive (Green)
|
basal TIMI flow
|
Process
|
|
Fabris E, Menzio S, Gregorio C, Pezzato A, Stolfo D, Aleksova A, et al. Effect of prehospital treatment in STEMI patients undergoing primary PCI. Catheter Cardiovasc Interv 2022. Medline
|
|
II
|
Supportive (Green)
|
1 year cardiovascular mortality
|
Patient
|
|
Goldstein P., Grieco N., Ince H., Danchin N., Ramos Y., Goedicke J., et al. Mortality in primary angioplasty patients starting antiplatelet therapy with prehospital prasugrel or clopidogrel: a 1-year follow-up from the European MULTIPRAC Registry. Vascular health and risk management 2016; 12:143-51. Medline
|
|
II
|
Supportive (Green)
|
Early reperfusion
|
Patient
|
PH-Paramedic
|
Hassan AK., Liem SS., van der Klev F., Bergheanu SC., et al. In-ambulance abciximab administration in STEMI patients prior to primary PCI is associated with smaller infarct size, improved LV function and lower incidence of heart failure: Results from the Leiden MISSION! Acute myocardial infarction treatment optimization program. Cath Cardio Interv 2009; 74(2)335-43. Medline
|
|
II
|
Supportive (Green)
|
all-cause mortality
|
Process
|
PH-Paramedic
|
Hautamäki M, Lyytikäinen LP, Eskola M, Lehtimäki T, Nikus K, Oksala N, et al. Prehospital Adenosine Diphosphate Receptor Blocker Use, Culprit Artery Flow, and Mortality in STEMI: The MADDEC Study. Clin Drug Investig 2021; 41(7):605–13. Medline
|
|
II
|
Supportive (Green)
|
Bleeding
|
Patient
|
PH-Paramedic
|
Hermanides RS., Ottervanger JP., Dambrink JH., et al. Risk of bleeding after prehospital administration of high dose tirofiban for ST elevation myocardial infarction. Int J Cardiol 2012; 157(1):86-90. Medline
|
|
II
|
Supportive (Green)
|
Analgesic effect
|
Patient
|
|
Hermanides RS., van Werkum JW., Ottervanger JP., et al. The effect of pre-hospital glycoprotein Iib-IIIa inhibitors on angiographic outcome in STEMI patients who are candidates for primary PCI. Catheter Cardiovasc Interv 2012; 79(6):956-64. Medline
|
|
II
|
Supportive (Green)
|
TIMI Flow
|
Process
|
|
Lupi A., Schaffer A., Lazzero M., Tessitori M., De ML., Rognoni A., et al. Pre-hospital ticagrelor in patients with ST-segment elevation myocardial infarction with long transport time to primary PCI facility. Cardiovascular revascularization medicine: including molecular interventions 2016; 17(8):528-34. Medline
|
|
II
|
Supportive (Green)
|
Stent thrombosis
|
Patient
|
ED-MD
|
Wang H, Pang X, Yang J, Shao J, Zhang J, Wang L, et al. Effect of Pre-Hospital Ticagrelor in Primary Percutaneous Coronary Intervention on Patients with ST-Segment Elevation Myocardial Infarction: A systematic review and meta-analysis. JPMA 2019; 69(9):1344-8. Medline
|
|
II
|
Supportive (Green)
|
Early reperfusion and short-term heart function
|
Process
|
In-Patient
|
Zhang Y, Hui J, Chen X. Preprocedural Ticagrelor Treatment was Associated with Improved Early Reperfusion and Reduced Short-term Heart Failure in East-Asian ST-segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention. Int J Gen Med 2021; 14():1927–38. Medline
|
|
II
|
Neutral (Yellow)
|
Bleeding
|
Patient
|
PH-Paramedic
|
Bergmeijer TO, van Oevelen M, Janssen PWA, Godschalk TC, Lichtveld RA, Kelder JC, et al. Safety of Ticagrelor Compared to Clopidogrel after Prehospital Initiation of Treatment. TH open 2018; 2(4):e357-68. Medline
|
|
II
|
Neutral (Yellow)
|
Net adverse clinical events (NACE) at 30 days
|
Patient
|
PH-Paramedic
|
Hermanides RS., Ottervanger JP., ten Berg JM., et al. Net clinical benefit of prehospital glycoprotein Iib/IIIa inhibitors in patients with ST-elevation myocardial infarction and high risk of bleeding: Effect of tirofiban in patients at high risk of bleeding using CRUSADE bleeding score. J Invasive Cardiol 2012; 24(3):84-9. Medline
|
|
II
|
Neutral (Yellow)
|
ST resolution post PCI
|
Patient
|
PH-Paramedic
|
Hermanides RS., van Houwelingen G., Ottervanger JP., et al. The impact of age on effects of pre-hospital initiation of high bolus dose of tirofiban before primary angioplasty for ST-elevation myocardial infarction. Cardiovasc Drugs Ther 2011; 25(4):323-30. Medline
|
|
II
|
Neutral (Yellow)
|
30 day mortality
|
Patient
|
|
Kilic S., Fabris E., Van't HA., Hamm CW., Lapostolle F., Lassen JF., et al. Thrombus aspiration and prehospital ticagrelor administration in ST-elevation myocardial infarction: Findings from the ATLANTIC trial. Am Heart J 2018; 196:1-8. Medline
|
|
II
|
Neutral (Yellow)
|
IRV patency, mortality and recurrent myocardial infarction
at 30-days and at one year
|
Patient
|
PH-Paramedic
|
Postma S., Dambrink JH., Ottervanger JP., et al. Early ambulance initiation versus in-hospital initiation of high dose clopidogrel in ST-segment elevation myocardial infarction. Thromb Haemost 2014; 112(3):606-13. Medline
|
|
II
|
Neutral (Yellow)
|
ST segment resolution
|
Patient
|
PH-Paramedic
|
Van't Hof AW., Ten Berg J., Heestermans T., Dill T., Funck RC., van Werkum W., et al. Prehospital initiation of tirofiban in patients with ST-elevation myocardial infarction undergoing primary angioplasty (On-TIME 2): a multicentre, double-blind, randomised controlled trial. Lancet 2008; 372(9638):537-546. Medline
|
|
III
|
Supportive (Green)
|
Pre-PCI ST-segment resolution
|
Patient
|
|
Bagai A., Goodman SG., Cantor WJ., Vicaut E., Bolognese L., Cequier A., et al. Duration of ischemia and treatment effects of pre- versus in-hospital ticagrelor in patients with ST-segment elevation myocardial infarction: Insights from the ATLANTIC study. Am Heart J 2018; 196:56-64. Medline
|
|
III
|
Supportive (Green)
|
Reperfusion
|
Patient
|
|
Cayla G., Lapostolle F., Ecollan P., Stibbe O., Benezet JF., Henry P., et al. Pre-hospital ticagrelor in ST-segment elevation myocardial infarction in the French ATLANTIC population. Int J Cardiol 2017; 244:49-53. Medline
|
|
III
|
Supportive (Green)
|
ST segment resolution
|
Patient
|
|
Fabris E., Van't HA., Hamm CW., Lapostolle F., Lassen JF., Goodman SG., et al. Impact of presentation and transfer delays on complete ST-segment resolution before primary percutaneous coronary intervention: insights from the ATLANTIC trial. EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 2017; 13(1):69-77. Medline
|
|
III
|
Supportive (Green)
|
30 day mortality
|
Patient
|
PH-Paramedic
|
Heestermans T., de Boer MJ., van Werkum JW., et al. Higher efficacy of pre-hospital tirofiban with longer pre-treatment time to primary PCI: Protection for the negative impact of time delay. EuroIntervention 2011; 7(4):442-8. Medline
|
|
III
|
Supportive (Green)
|
ST segment resolution
|
Patient
|
PH-Paramedic
|
Timmer JR., ten Berg J., Heestermans AA., et al. Pre-hospital administration of tirofiban in diabetic patients with ST-elevation myocardial infarction undergoing primary angioplasty: A sub-analysis of the on-time 2 trial. EuroIntervention 2010; 6(3):336-342. Medline
|
|
III
|
Neutral (Yellow)
|
TIMI flow
|
Process
|
|
Auffret V., Oger E., Leurent G., et al. Efficacy of pre-hospital use of glycoprotein Iib/IIIa inhibitors in ST-segment elevation myocardial infarction before mechanical reperfusion in a rapid-transfer network (from the acute myocardial infarction registry of brittany). Am J Cardiol 2014; 114(2):214-23. Medline
|
|
III
|
Neutral (Yellow)
|
Composite clinical end point
|
Process
|
PH-Paramedic
|
Hanefeld C., Sirtl C., Spiecker M., et al. Prehospital therapy with the platelet glycoprotein Iib/IIIa inhibitor eptifibatide in patients with suspected acute coronary syndromes: The bochum feasibility study. Chest 2004; 126(3):935-41. Medline
|
|
III
|
Neutral (Yellow)
|
Infarct size at 6 months
|
Patient
|
ED-MD
|
Petronio AS., De Carlo M., Strata E., et al. Impact of early abciximab administration on infarct size in patients with ST-elevation myocardial infarction. Int J Cardiol 2012; 155(2):230-5. Medline
|
Bypass/Direct to PCI
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
30 day Mortality
|
Patient
|
PH-Paramedic
|
Armstrong P. A comparison of pharmacologic therapy with/without timely coronary intervention vs. primary percutaneous intervention early after ST-elevation myocardial infarction: the WEST study. European Heart Journal 2006; 27:1530-8. Medline
|
|
I
|
Supportive (Green)
|
Survival
|
Patient
|
PH-Bystander
|
Bata I., Armstrong PW., Westerhout CM., Travers A., Sookram S., Caine E., et al. Time from first medical contact to reperfusion in ST elevation myocardial infarction: a Which Early ST Elevation Myocardial Infarction Therapy (WEST) substudy. Can J Cardiol 2009; 25(8):463-8. Medline
|
|
I
|
Supportive (Green)
|
Mortality at 5 years
|
Patient
|
PH-Paramedic
|
Bonnefoy E., Steg PG., Boutitie F., et al. Comparison of primary angioplasty and pre-hospital fibrinolysis in acute myocardial infarction (CAPTIM) trial: A 5-year follow-up. Eur Heart J 2009; 30(13):1598-606. Medline
|
|
I
|
Supportive (Green)
|
Reinfarction, Stroke, All-cause mortality
|
Patient
|
ED-MD
|
Dalby M., et al. Transfer for PCI versus immediate thrombolysis for AMI: a meta-analysis. Circulation 2003; 108:1809-14. Medline
|
|
I
|
Supportive (Green)
|
All cause mortality at 30 days
|
Patient
|
|
Postma S., Kolkman E., Rubinstein SM., Jansma EP., De LG., Suryapranata H., et al. Field triage in the ambulance versus referral via non-percutaneous coronary intervention centre in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: A systematic review. European heart journal Acute cardiovascular care 2017; 6(5):396-403. Medline
|
|
I
|
Neutral (Yellow)
|
Survival
|
Patient
|
PH-Paramedic
|
Brooks S. Prehospital Triage and Direct Transport of Patients with ST-elevation Myocardial Infraction to Primary Percutaneous Coronary Intervention Centres: a systematic review and meta-analysis. CJEM 2009; 11(5):481-92. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
|
Almawiri A., Jan V., Ziad A., Martin J., Josef S. Mortality benefit of primary transportation to a PCI-capable center persists through an eight-year follow-up in patients with ST-segment elevation myocardial infarction. J Interv Cardiol 2017; 30(6):522-6. Medline
|
|
II
|
Supportive (Green)
|
Pain to needle time
|
Process
|
PH-Paramedic
|
Amit G., Cafri C., Gilutz H., Ilia R., Zahger D. Benefit of direct ambulance to CCU admission of AMI patients undergoing PCI. International J of Cardiol 2007; 119:355-8. Medline
|
|
II
|
Supportive (Green)
|
Time to reperfusion
|
Process
|
|
Bata A., Quraishi AUR., Love M., Title L., Beydoun H., Lee T., et al. Initial experience with pre-activation of the cardiac catheterization lab and emergency room bypass for patients with ST-elevation myocardial infarction in Halifax, Nova Scotia. Int J Cardiol 2016; 222:645-7. Medline
|
|
II
|
Supportive (Green)
|
Symptom onset to balloon times
|
Process
|
PH-Paramedic
|
Carstensen S., et al. Field triage to primary angioplasty combined with emergency department bypass reduces treatment delays and is associated with improved outcome. Eur Heart J 2007; 28:2313-9. Medline
|
|
II
|
Supportive (Green)
|
Symptom to reperfusion, Mortality
|
Process
|
PH-Paramedic
|
Dalby M., Kharbanda R., Ghimire G., et al. Achieving routine sub 30 minute door-to-balloon times in a high volume 24/7 primary angioplasty center with autonomous ambulance diagnosis and immediate catheter laboratory access. Am Heart J 2009; 158(5):829-35. Medline
|
|
II
|
Supportive (Green)
|
Time to revascularization.
|
Process
|
PH-Paramedic
|
Demandt J, Koks A, Sagel D, et al. Prehospital risk assessment and direct transfer to a percutaneous coronary intervention centre in suspected acute coronary syndrome. Heart 2023. Medline
|
|
II
|
Supportive (Green)
|
Door to balloon time
|
Process
|
PH-Paramedic
|
Eckstein M., Koenig W., Kaji A., Tadeo R. Implementation of specialty centers for patients with STEMI: The Los Angeles STEMI receiving center project. Prehosp Emerg Care 2009; 13:215-22. Medline
|
|
II
|
Supportive (Green)
|
Time to reperfusion
|
Process
|
PH-Paramedic
|
Fosbol EL., Granger CB., Jollis JG., et al. The impact of a statewide pre-hospital STEMI strategy to bypass hospitals without percutaneous coronary intervention capability on treatment times. Circulation 2013; 127(5):604-12. Medline
|
|
II
|
Supportive (Green)
|
EMS call to needle time
|
Process
|
PH-Paramedic
|
Kelly AM., Kerr D., Patrick I., Walker T. Call-to-needle times for thrombolysis in AMI in Victoria. MJA 2003; 178:381-5. Medline
|
|
II
|
Supportive (Green)
|
In-hospital mortality
|
Patient
|
PH-Paramedic
|
Kritikou I., Chalkias A., Koutsovasilis A., Xanthos T. Characteristics and survival to discharge of patients with STEMI between a PPCI-capable hospital and a non-PPCI hospital: A prospective observational study. Acute Card Care 2014; 16(4):118-22. Medline
|
|
II
|
Supportive (Green)
|
Patient stability
|
Patient
|
|
Kwong JL., Ross G., Turner L., Olynyk C., Cheskes S., Thurston A., et al. Evaluation of a primary care paramedic STEMI bypass guideline. CJEM. 2018; 20(6):850-856. Medline
|
|
II
|
Supportive (Green)
|
Safety and feasibility
|
Process
|
PH-Paramedic
|
Le May MR., Davies RF., Dionne R., et al. Comparison of early mortality of paramedic-diagnosed ST-segment elevation myocardial infarction with immediate transport to a designated primary percutaneous coronary intervention center to that of similar patients transported to the nearest hospital. Am J Cardiol 2006; 98(10):1329-1333. Medline
|
|
II
|
Supportive (Green)
|
Safety and feasibility
|
Process
|
PH-Paramedic
|
Le May MR., Davies RF., Dionne R., et al. Comparison of early mortality of paramedic-diagnosed ST-segment elevation myocardial infarction with immediate transport to a designated primary percutaneous coronary intervention center to that of similar patients transported to the nearest hospital. Am J Cardiol 2006; 98(10):1329-1333. Medline
|
|
II
|
Supportive (Green)
|
Door to balloon time
|
Process
|
PH-Paramedic
|
Le May MR., et al. A City-wide protocol for primary PCI in ST-segment elevation myocardial infarction. NEMJ 2008; 358:231-40. Medline
|
|
II
|
Supportive (Green)
|
Mortality at 180 days
|
Patient
|
PH-Paramedic
|
Le May MR., Wells GA., So DY., et al. Reduction in mortality as a result of direct transport from the field to a receiving center for primary percutaneous coronary intervention. J Am Coll Cardiol 2012; 60(14):1223-1230. Medline
|
|
II
|
Supportive (Green)
|
Symptom to needle time
|
Process
|
PH-Paramedic
|
Leleu H., Capuano F., Ferrua M., Nitenberg G., Minvielle E., Schiele F. Symptom-to-needle times in ST-segment elevation myocardial infarction: Shortest route to a primary coronary intervention facility. Arch Cardiovasc Dis 2013; 106(3):162-168. Medline
|
|
II
|
Supportive (Green)
|
Symptom to needle time
|
Process
|
PH-Paramedic
|
Leleu H., Capuano F., Ferrua M., Nitenberg G., Minvielle E., Schiele F. Symptom-to-needle times in ST-segment elevation myocardial infarction: Shortest route to a primary coronary intervention facility. Arch Cardiovasc Dis 2013; 106(3):162-168. Medline
|
|
II
|
Supportive (Green)
|
death, non-fatal myocardial infarction, and stroke
|
Patient
|
PH-Paramedic
|
Machecourt J., et al. Primary angioplasty is cost-minimizing compared with pre-hospital thrombolysis for patients within 60 min of a PCI center. J Am Coll Cardiol 2005; 45:515-24. Medline
|
|
II
|
Supportive (Green)
|
Door to balloon time
|
Process
|
PH-Paramedic
|
Rokos IC., French WJ., Koenig WJ., et al. Integration of pre-hospital electrocardiograms and ST-elevation myocardial infarction receiving center (SRC) networks: Impact on door-to-balloon times across 10 independent regions. JACC Cardiovasc Interv 2009; 2(4):339-46. Medline
|
|
II
|
Supportive (Green)
|
Mortality post-1 yr
|
Patient
|
PH-Paramedic
|
Savage ML, Hay K, Murdoch DJ, Doan T, Bosley E, Walters DL, Denman R, Ranasinghe I, Raffel OC. Clinical Outcomes in Pre-Hospital Activation and Direct Cardiac Catheterisation Laboratory Transfer of STEMI for Primary PCI. Hear Lung Circ 2022. Medline
|
|
II
|
Supportive (Green)
|
time to device
|
Process
|
|
Shavelle DM., Bosson N., Thomas JL., Kaji AH., Sung G., French WJ., et al. Outcomes of ST Elevation Myocardial Infarction Complicated by Out-of-Hospital Cardiac Arrest (from the Los Angeles County Regional System). Am J Cardiol 2017; 120(5):729-33. Medline
|
|
II
|
Supportive (Green)
|
Feasibility
|
Process
|
PH-Paramedic
|
Sillesen M., et al. Referral of patients with STEMI directly to the cath suite based on prehospital teletransmission of 12 lead ECG. J Electrocardiography 2008; 41:49-53. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Stenestrand U., Lindback J., Wallentin L., RIKS-HIA Registry. Long-term outcome of primary percutaneous coronary intervention vs prehospital and in-hospital thrombolysis for patients with ST-elevation myocardial infarction. JAMA 2006; 296(14):1749-1756. Medline
|
|
II
|
Supportive (Green)
|
Treatment delay
|
Patient
|
PH-Paramedic
|
Terkelsen CJ., et al. Reduction of treatment delay in patients with STEMI: impact of prehospital diagnosis and direct referral to primary PCI. Eur Heart J 2005; 26:770-7. Medline
|
|
II
|
Supportive (Green)
|
Infarct Diagnosis
|
Patient
|
PH-Paramedic
|
van 't Hof AW., Rasoul S., van de Wetering H., et al. Feasibility and benefit of prehospital diagnosis, triage, and therapy by paramedics only in patients who are candidates for primary angioplasty for acute myocardial infarction. Am Heart J 2006; 151(6):1255.e1-1255.e5. Medline
|
|
II
|
Supportive (Green)
|
30 day primary endpoint (death, re-infarction, shock, CHF)
|
Patient
|
|
Welsh RC., Goldstein P., Sinnaeve P., Ostojic MC., Zheng Y., Danays T., et al. Relationship between community hospital versus pre-hospital location of randomisation and clinical outcomes in ST-elevation myocardial infarction patients: insights from the Stream study. European heart journal Acute cardiovascular care 2017:2048872617700872. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Zahn R., Schiele R., Gitt AK., et al. Impact of prehospital delay on mortality in patients with acute myocardial infarction treated with primary angioplasty and intravenous thrombolysis. Am Heart J 2001; 142(1):105-111. Medline
|
|
II
|
Neutral (Yellow)
|
ST segment resolution
|
Patient
|
|
Fabris E., Van't HA., Hamm CW., Lapostolle F., Lassen JF., Goodman SG., et al. Impact of presentation and transfer delays on complete ST-segment resolution before primary percutaneous coronary intervention: insights from the ATLANTIC trial. EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 2017; 13(1):69-77. Medline
|
|
II
|
Neutral (Yellow)
|
FMC to Device time
|
Process
|
|
Fordyce CB., Cairns JA., Singer J., Lee T., Park JE., Vandegriend RA., et al. Evolution and Impact of a Regional Reperfusion System for ST-Elevation Myocardial Infarction. Can J Cardiol 2016; 32(10):1222-30. Medline
|
|
III
|
Supportive (Green)
|
Reduction in door-to-balloon time
|
Process
|
PH-Paramedic
|
Van de Loo A., Saurbier B., Kalbhenn J., Koberne F., Zehender M. Primary PCI in AMI: Direct transportation to catheterization laboratory in emergency teams reduces door-to-balloon time. Clin Cardiol 2006; 29:112-6. Medline
|
Chest pain prediction tool
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
Diagnosis of NSTEMI
|
Process
|
Other
|
Demandt JPA, Zelis JM, Koks A, Smits GHJM, van der Harst P, Tonino PAL, Dekker LRC, van Het Veer M, Vlaar PJ. Prehospital risk assessment in patients suspected of non-ST-segment elevation acute coronary syndrome: a systematic review and meta-analysis. BMJ Open 2022; 12(4):e057305. Medline
|
|
I
|
Neutral (Yellow)
|
Negitive predictive value
|
Process
|
PH-Paramedic
|
Khaleghi Rad M, Pirmoradi MM, Doosti-Irani A, Thiruganasambandamoorthy V, Mirfazaelian H. The performance of HEAR score for identification of low-risk chest pain: a systematic review and meta-analysis. Eur J Emerg Med 2022; 29(3):173–87. Medline
|
|
I
|
Neutral (Yellow)
|
Prediction of MACE
|
Process
|
ED-MD
|
O'Rielly CM, Harrison TG, Andruchow JE, Ronksley PE, Sajobi T, et al. Risk Scores for Clinical Risk Stratification of Emergency Department Patients With Chest Pain but No Acute Myocardial Infarction: A Systematic Review. Can J Cardiol March 2023; 39(3):304-10. Medline
|
|
II
|
Supportive (Green)
|
NPV as measures of ability to rule out MI.
|
Process
|
ED-MD
|
Bang C, Anderson CF, Lauridsen KG, Frederiksen CA, Schmidt M, Jensen T, et al. Rapid Rule-Out of Myocardial Infarction After 30 Minutes as an Alternative to 1 Hour: The RACING-MI Cohort Study. Ann Emerg Med 2021. Medline
|
|
II
|
Supportive (Green)
|
Cost savings
|
Process
|
PH-Paramedic
|
Dawson LP, Nehme E, Nehme Z, Zomer E, Bloom J, et al. Chest Pain Management Using Prehospital Point-of-Care Troponin and Paramedic Risk Assessment. JAMA Intern Med March 2023; 183(3):203-11. Medline
|
|
II
|
Supportive (Green)
|
Time to treatment
|
Process
|
PH-Paramedic
|
Demandt J, Koks A, Sagel D, et al. Prehospital risk assessment and direct transfer to a percutaneous coronary intervention centre in suspected acute coronary syndrome. Heart 2023. Medline
|
|
II
|
Supportive (Green)
|
Prediction of major adverse cardiac events
|
Process
|
ED-MD
|
Fiore G, Pinto G, Preda A, et al. Performances of HEART score to predict 6-month prognostic of emergency department patients with chest pain: a retrospective cohort analysis. Eur J Emerg Med April 2023; 30(3):179-85. Medline
|
|
II
|
Supportive (Green)
|
MACE at 30 days
|
Patient
|
ED-MD
|
Khand AU, Backus B, Campbell M, et al. HEART Score Recalibration Using Higher Sensitivity Troponin T. Ann Emerg Med October 2023; 82(4):449-62. Medline
|
|
II
|
Supportive (Green)
|
Risk score
|
Process
|
ED-MD
|
Smulders KRR, Demandt JPA, Vlaar PJ. Early risk assessment in patients with suspected NSTE-ACS; a retrospective cohort study. Am J Emerg Med 2022;60:106–15. Medline
|
|
II
|
Supportive (Green)
|
Prediction of patients with increased risk of mortality
|
Process
|
PH-Paramedic
|
Solà-Muñoz S, Jorge M, Jiménez-Fàbrega X, et al. Prehospital stratification and prioritisation of non-ST-segment elevation acute coronary syndrome patients (NSTEACS): the MARIACHI scale. Intern Emerg Med 2023. Medline
|
|
II
|
Supportive (Green)
|
Prediction MACE at 30 days.
|
Process
|
ED-MD
|
Todd F, Duff J, Carlton E. Identifying low-risk chest pain in the emergency department without troponin testing: a validation study of the HE-MACS and HEAR risk scores. Emerg Med J 2022; 39(7):515–8. Medline
|
|
II
|
Supportive (Green)
|
Predictive Value
|
Patient
|
PH-Paramedic & MD
|
Wibring K, Lingman M, Herlitz J, Amin S, Bång A. Prehospital stratification in acute chest pain patient into high risk and low risk by emergency medical service: a prospective cohort study. BMJ Open 2021; 11(4):e044938. Medline
|
|
II
|
Neutral (Yellow)
|
Diagnosis of type 1 AMI
|
Process
|
PH-Paramedic
|
Alotaibi A, Alghamdi A, Martin GP, et al. External validation of the Manchester Acute Coronary Syndromes ECG risk model within a pre-hospital setting. Emerg Med J 2023; 40(6):431-6. Medline
|
|
II
|
Neutral (Yellow)
|
Predictive value
|
Patient
|
Other
|
Casarin C, Pirot AS, Gregoire C, Van Der Haert L, Vanden Berghe P, Castanares-Zapatero D, et al. Improving the performance of a triage scale for chest pain patients admitted to emergency departments: combining cardiovascular risk factors and electrocardiogram. BMC Emerg Med 2022; 22(1):118. Medline
|
|
II
|
Neutral (Yellow)
|
30 day MACE (i.e. all-cause death, myocardial infarction, or coronary revascularization)
|
Patient
|
PH-Paramedic
|
Popp LM, Ashburn NP, Paradee BE, et al. Prehospital Comparison of the HEAR and HE-MACS Scores for 30-Day Adverse Cardiac Events. Prehosp Emerg Care January 2024; 28(1):23-9. Medline
|
|
II
|
Neutral (Yellow)
|
Prediction of major adverse cardiac event (MACE)/ mortality
|
Patient
|
PH-Paramedic
|
Sagel D, Vlaar PJ, van Roosmalen R, Waardenburg I, Nieuwland W, Lettinga R, et al. Prehospital risk stratification in patients with chest pain. Emerg Med J 2021; 38(11):814–9. Medline
|
|
II
|
Neutral (Yellow)
|
Prediction of 30 day MACE outcomes
|
Patient
|
ED-MD
|
Schrader CD, Kumar D, Zhou Y, Meyering S, Saltarelli N, Alanis N, et al. Using HEART2 score to risk stratify chest pain patients in the Emergency Department: an observational study. BMC Cardiovasc Disord 2022; 22(1):79. Medline
|
|
II
|
Neutral (Yellow)
|
Risk stratification
|
Patient
|
PH-Paramedic
|
Stopyra JP, Snavely AC, Ashburn NP, O'Neill J, Paradee BE, Hehl B, Vorrie J, Wells M, Nelson RD, Hendley NW, Miller CD, Mahler SA. Performance of Prehospital Use of Chest Pain Risk Stratification Tools: The RESCUE Study. Prehosp Emerg Care 2022; 1–6. Medline
|
|
II
|
Opposes (Red)
|
MACE at 30-days
|
Patient
|
PH-Paramedic
|
Cooper JG, Ferguson J, Donaldson LA, et al. Could paramedics use the HEART Pathway to identify patients at low-risk of myocardial infarction in the prehospital setting? Am Hear J May 2024; 271:182-7. Medline
|
|
II
|
Opposes (Red)
|
Observed MACE ( Myocardial Acute Coronary Event ) at 30 days.
|
Process
|
PH-Paramedic & MD
|
Cooper JG, Ferguson J, Donaldson LA, et al. Performance of a prehospital HEART score in patients with possible myocardial infarction: a prospective evaluation. Emerg Med J 2023; 40(7):474-81. Medline
|
|
III
|
Supportive (Green)
|
Prediction of major adverse cardiac events
|
Patient
|
PH-Paramedic
|
Cooper JG, Ferguson J, Donaldson LA, Black KMM, Livock KJ, Horrill JL, et al. The Ambulance Cardiac Chest Pain Evaluation in Scotland Study (ACCESS): A Prospective Cohort Study. Ann Emerg Med 2021; 77(6):575-88. Medline
|
|
III
|
Supportive (Green)
|
Risk Classification
|
Process
|
Other
|
Wibring K, Lingman M, Herlitz J, Ashfaq A, Bång A. Development of a prehospital prediction model for risk stratification of patients with chest pain. Am J Emerg Med 2022; 51:26–31. Medline
|
|
III
|
Neutral (Yellow)
|
Time to PCI
|
Process
|
PH-Paramedic
|
Demandt JPA, Koks A, Haest R, Heijmen E, Thijssen E, Otterspoor LC, et al. Prehospital triage of patients with suspected non-ST-segment elevation acute coronary syndrome: Rationale and design of the TRIAGE-ACS study. Contemp Clin Trials 2022; 119:106854. Medline
|
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Demandt JPA, Koks A, Sagel D, et al. External validation of the preHEART score and comparison with current clinical risk scores for prehospital risk assessment in patients with suspected NSTE-ACS. Emerg Med J. July 2024. Medline
|
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Gol M, Bayram N, Demir O, Karacabey S, Sanri E. SVEAT score: Acute chest pain risk stratification. Am J Emerg Med June 2024; 80:24-8. Medline
|
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Gol M, Bayram N, Demir O, Karacabey S, Sanri E. SVEAT score: Acute chest pain risk stratification. Am J Emerg Med June 2024; 80:24-8. Medline
|
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Murali N, Ali A, Okolo R, et al. Assessing risk of major adverse cardiac events among patients with chest pain and cocaine use using the HEART score. Am J Emerg Med June 2024; 80:29-34. Medline
|
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Suh EH, Mumma BE, Einstein AJ, Chang BC, et al. External Validation of the Recalibrated HEART Score for Evaluation of Possible Acute Coronary Syndrome. Am J Cardiol Aug 2024; 229:13-21. Medline
|
Fibrinolysis
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
30 day Mortality
|
Patient
|
PH-Paramedic
|
Armstrong P. A comparison of pharmacologic therapy with/without timely coronary intervention vs. primary percutaneous intervention early after ST-elevation myocardial infarction: the WEST study. European Heart Journal 2006; 27:1530-8. Medline
|
|
I
|
Supportive (Green)
|
30 day Mortality
|
Patient
|
|
Armstrong PW., Gershlick AH., Goldstein P., et al. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N Engl J Med 2013; 368(15):1379-87. Medline
|
|
I
|
Supportive (Green)
|
exclude
|
Process
|
PH-Paramedic
|
Bata I., Armstrong PW., Westerhout CM., Travers A., Sookram S., Caine E., et al. Time from first medical contact to reperfusion in ST elevation myocardial infarction: a Which Early ST Elevation Myocardial Infarction Therapy (WEST) substudy. Can J Cardiol 2009; 25(8):463-8. Medline
|
|
I
|
Supportive (Green)
|
30 day survival.
|
Patient
|
PH-Paramedic
|
Boissel JP. The European myocardial infarction project: An assessment of pre-hospital thrombolysis. Internat J Card 1995; 49(suppl):S29-37. Medline
|
|
I
|
Supportive (Green)
|
Composite of death, non-fatal reinfarction, and non-fatal disabling stroke at 30 days.
|
Patient
|
PH-Paramedic
|
Bonnefoy E., et al. Primary angioplasty versus prehospital fibrinolysis in AMI: A randomised study. Lancet 2002; 360:825-9. Medline
|
|
I
|
Supportive (Green)
|
Mortality at 5 years
|
Patient
|
PH-Paramedic
|
Bonnefoy E., Steg PG., Boutitie F., et al. Comparison of primary angioplasty and pre-hospital fibrinolysis in acute myocardial infarction (CAPTIM) trial: A 5-year follow-up. Eur Heart J 2009; 30(13):1598-606. Medline
|
|
I
|
Supportive (Green)
|
Event-free survival at 2 years
|
Patient
|
PH-Paramedic
|
Brouwer MA., et al. Influence of early prehospital thrombolysis on mortality & event-free survival (The myocardial infarction triage and intervention [MITI] randomized trial). Am J Cardiol 1996; 78:497-502. Medline
|
|
I
|
Supportive (Green)
|
Initiation of therapy
|
Process
|
|
Dussoix P., Reuille O., Verin V., Gaspoz JM., Unger PF. Time savings with prehospital thrombolysis in an urban area. Eur J Emer Med 2003; 10:2-5. Medline
|
|
I
|
Supportive (Green)
|
Resolution of ST segment elevation
|
Patient
|
PH-Paramedic
|
Kudenchuk PJ., Maynard C., Cobb LA., et al. Utility of the prehospital electrocardiogram in diagnosing acute coronary syndromes: The myocardial infarction triage and intervention (MITI) project. JACC 1998; 32(1):17-27. Medline
|
|
I
|
Supportive (Green)
|
All-cause hospital mortality
|
Patient
|
PH-Paramedic
|
Morrison LJ., Verbeek PR., McDonald AC., Sawadsky BV., Cook DJ. Mortality and prehospital thrombolysis for acute myocardial infarction: A meta-analysis. JAMA 2000; 283(20):2686-92. Medline
|
|
I
|
Supportive (Green)
|
-
|
Patient
|
|
Morrison LJ., Verbeek R., McDonald A., et al. Mortality and prehospital thromblysis for acute myocardial infarction. JAMA 2000; 283:2686-92. Medline
|
|
I
|
Supportive (Green)
|
Survival
|
Patient
|
PH-Paramedic
|
Rawles J. GREAT: 10 year survival of patients with AMI in a randomized comparison of prehospital and hospital thrombolysis. Heart 2003; 89:563-4. Medline
|
|
I
|
Supportive (Green)
|
Survival
|
Patient
|
PH-Paramedic
|
Rawles JM. Quantification of the benefit of earlier thrombolytic therapy: Five year results of the Grampian Region Early Anistreplase Trial (GREAT). JACC 1997; 30(5):1181-6. Medline
|
|
I
|
Supportive (Green)
|
30 day mortality
|
Patient
|
PH-Paramedic
|
Steg PG., et al. Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty (CAPTIM). Circulation 2003; 108:2851-2856. Medline
|
|
I
|
Supportive (Green)
|
Infarct size, functional coronary intervention in acute myocardial infarction. Eur Heart J
|
Patient
|
PH-Paramedic
|
Thiele H., Engelmann L., Elsner K., et al. Comparison of pre-hospital combination-fibrinolysis plus conventional care with pre-hospital combination-fibrinolysis plus facilitated percutaneous coronary intervention in acute myocardial infarction. Eur Heart J 2005; 26(19):1956-1963. Medline
|
|
I
|
Supportive (Green)
|
Complete ST-segment recovery
|
Patient
|
PH-Paramedic
|
Thiele H., et al. ST-segment recovery and prognosis in patients with STEMI reperfused by prehospital combination fibrinolysis, prehospital initiated facilitated percutaneous coronary intervention, or PCI. Am J Cardiol 2006; 98:1132-9. Medline
|
|
I
|
Supportive (Green)
|
Complete ST-segment recovery
|
Patient
|
PH-Paramedic
|
Thiele H., et al. ST-segment recovery and prognosis in patients with STEMI reperfused by prehospital combination fibrinolysis, prehospital initiated facilitated percutaneous coronary intervention, or PCI. Am J Cardiol 2006; 98:1132-9. Medline
|
|
I
|
Supportive (Green)
|
Reduction in infarct size
|
Patient
|
PH-Paramedic
|
Weaver DW., Cerqueira M., Hallstrom AP., et al. Prehospital-initiated vs hospital-initiated thrombolytic therapy. JAMA 1993; 270(10):1211-1216. Medline
|
|
I
|
Supportive (Green)
|
1 year mortality
|
Patient
|
PH-Paramedic
|
Westerhout CM., Bonnefoy E., Welsh RC., Steg PG., Boutitie F., Armstrong PW. The influence of time from symptom onset and reperfusion strategy on 1-year survival in ST-elevation myocardial infarction: A pooled analysis of an early fibrinolytic strategy versus primary percutaneous coronary intervention from CAPTIM and WEST. Am Heart J 2011; 161(2):283-290. Medline
|
|
II
|
Supportive (Green)
|
Survival
|
Patient
|
PH-Paramedic
|
Bjorklund E., Stenestrand U., Lindback J., et al. Prehospital diagnosis and start of treatment reduces time delay and mortality in real-life patients with STEMI. J Electrocardiol 2005; 38(S4):186. Medline
|
|
II
|
Supportive (Green)
|
30 day and 1 year mortality
|
Patient
|
PH-Paramedic
|
Björklund E., Stenestrand U., Lindbäck J., Svensson L., Wallentin L., Lindahl B. Pre-hospital thrombolysis delivered by paramedics is associated with reduced time delay and mortality in ambulance-transported real-life patients with ST-elevation myocardial infarction. Eur Heart J 2006; 27:1146-52. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
|
Grijseels EWM., Bouten MJM., Lenderink T., et al. Pre-hospital thrombolytic therapy with either alteplase or streptokinase. Euro Heart J 1995; 16:1833-8. Medline
|
|
II
|
Supportive (Green)
|
Artery patency
|
Patient
|
PH-Paramedic
|
Juliard JM., Himbert D., Cristofini P., et al. A matched comparison of the combination of prehospital thrombolysis and standby rescue angioplasty with primary angioplasty. Am J Card 1999; 83:305-10. Medline
|
|
II
|
Supportive (Green)
|
Aborted MI
|
Process
|
PH-Paramedic
|
Lamfers EJ., Schut A., Hertzberger DP., et al. Prehospital versus hospital fibrinolytic therapy using automated versus cardiologist electrocardiographic diagnosis of myocardial infarction: Abortion of myocardial infarction and unjustified fibrinolytic therapy. Am Heart J. 2004; 147(3):509-515. Medline
|
|
II
|
Supportive (Green)
|
Aborted MI
|
Process
|
PH-Paramedic
|
Lamfers EJ., Schut A., Hertzberger DP., et al. Prehospital versus hospital fibrinolytic therapy using automated versus cardiologist electrocardiographic diagnosis of myocardial infarction: Abortion of myocardial infarction and unjustified fibrinolytic therapy. Am Heart J. 2004; 147(3):509-515. Medline
|
|
II
|
Supportive (Green)
|
Time to treatment
|
Process
|
PH-Paramedic
|
Lamfers EJ., Schut A., Hooghoudt TE., et al. Prehospital thrombolysis with reteplase: The Nijmegen/Rotterdam study. Am Heart J. 2003; 146(3):479-483. Medline
|
|
II
|
Supportive (Green)
|
DTB time
|
Process
|
PH-Paramedic
|
Mockel M., Bocksch W., Strohm S., et al. Facilitated percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction: Comparison of prehospital tirofiban versus fibrinolysis before direct PCI. Int J Cardiol 2005; 103(2):193-200. Medline
|
|
II
|
Supportive (Green)
|
Amount of time saved by prehospital administration of rPA
|
Process
|
PH-Paramedic
|
Morrow DA., Antman EM., Sayah A., et al. Evaluation of the time saved by prehospital initiation of reteplase for ST-elevation myocardial infarction: Results of the early retavase-thrombolysis in myocardial infarction (ER-TIMI) 19 trial. J Am Coll Cardiol 2002; 40(1):71-7. Medline
|
|
II
|
Supportive (Green)
|
Adverse effects occurring in ambulance.
|
Patient
|
PH-Paramedic
|
Ranchord AM., Prasad S., Matsis P., Harding SA. Paramedic-administered prehospital thrombolysis is safe and reduces time to treatment. N Z Med J 2009; 122(1302):47-53. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
|
Roule V., Ardouin P., Blanchart K., Lemaitre A., Wain-Hobson J., Legallois D., et al. Prehospital fibrinolysis versus primary percutaneous coronary intervention in ST-elevation myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Crit Care 2016; 20(1):359. Medline
|
|
II
|
Supportive (Green)
|
30 day mortality
|
Patient
|
|
Solhpour A., Chang KW., Arain SA., Balan P., Zhao Y., Loghin C., et al. Comparison of 30-day mortality and myocardial scar indices for patients treated with prehospital reduced dose fibrinolytic followed by percutaneous coronary intervention versus percutaneous coronary intervention alone for treatment of ST-elevation myocard. Catheterization and cardiovascular interventions: official journal of the Society for Cardiac Angiography & Interventions 2016; 88(5):709-15. Medline
|
|
II
|
Supportive (Green)
|
Feasibility
|
Patient
|
PH-Paramedic
|
Svensson L., Karlsson T., Nordlander R., Wahlin M., Zedigh C., Herlitz J. Safety and delay time in prehospital thrombolysis of acute myocardial infarction in urban and rural areas in sweden. Am J Emerg Med 2003; 21(4):263-270. Medline
|
|
II
|
Supportive (Green)
|
quality of life
|
Patient
|
|
Vaisanen O., Makijarvi M., Silfvast T. Quality of life of elderly patients after prehospital thrombolytic therapy. Resuscitation 2005; 66(2):183-188. Medline
|
|
II
|
Supportive (Green)
|
Feasibility
|
Patient
|
PH-Paramedic
|
Welsh RC., Travers A., Senaratne M., Williams R., Armstrong PW. Feasibility & applicability of paramedic-based prehospital fibrinolysis in a large North American center. Am Heart J 2006; 152:1007-14. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Zahn R., Schiele R., Gitt AK., et al. Impact of prehospital delay on mortality in patients with acute myocardial infarction treated with primary angioplasty and intravenous thrombolysis. Am Heart J 2001; 142(1):105-111. Medline
|
|
II
|
Neutral (Yellow)
|
Death re-MI and stroke
|
Patient
|
PH-Paramedic
|
Bonnefoy E., Steg PG., Chabaud S., et al. Is primary angioplasty more effective than prehospital fibrinolysis in diabetics with acute myocardial infarction? Data from the CAPTIM randomized clinical trial. Eur Heart J 2005; 26(17):1712-8. Medline
|
|
II
|
Neutral (Yellow)
|
Identification of AMI reperfusion candidates
|
Process
|
PH-Paramedic
|
Gibler WB., et al. Prehospital diagnosis and treatment of AMI: A North-South perspective. Am Heart J 1991; 121:1-11. Medline
|
|
II
|
Neutral (Yellow)
|
Frequency and determinants
of re-infarction
|
Process
|
PH-Paramedic
|
Horne S., Weston C., Quinn T., et al. The impact of pre-hospital thrombolytic treatment on re-infarction rates: Analysis of the myocardial infarction national audit project (MINAP). Heart 2009; 95(7):559-63. Medline
|
|
II
|
Neutral (Yellow)
|
Aborted myocardial infarction
|
Patient
|
PH-Paramedic
|
Jackson L., Kendall J., Castle N. Does prehospital thrombolysis increase the proportion of patients who have an aborted myocardial infarction? Emerg Med J 2009; 26(3):206-9. Medline
|
|
II
|
Neutral (Yellow)
|
Survival
|
Patient
|
PH-Paramedic
|
Ryynanen OP., Iirola T., Reitala J., Palve H., Malmivaara A. Is advanced life support better than basic life support in prehospital care? A systematic review. Scand J Trauma Resusc Emerg Med 2010; 18:62-7241-18-62. Medline
|
|
III
|
Supportive (Green)
|
Reperfusion
|
Patient
|
ED-MD
|
Kosits L. Administration of tenecteplase after prolonged cardiopulmonary resuscitation in a 46-year-old man with ventricular fibrillation. J Emerg Nurs 2003; 29(6):507-10. Medline
|
|
III
|
Supportive (Green)
|
Mortality at 1 and 12 months
|
Patient
|
PH-Paramedic
|
McLean S., Wild S., Connor P., Flapan AD. Treating ST elevation myocardial infarction by primary percutaneous coronary intervention, in-hospital thrombolysis and prehospital thrombolysis. An observational study of timelines and outcomes in 625 patients. Emerg Med J 2011; 28(3):230-6. Medline
|
|
III
|
Supportive (Green)
|
call to needle time)
|
Process
|
PH-Paramedic
|
Pedley DK., et al. Prospective observation cohort study of time saved by prehospital thrombolysis for ST elevation myocardial infarction delivered by paramedics. BMJ 2003; 327(405):22-6. Medline
|
|
III
|
Supportive (Green)
|
Feasibility
|
Patient
|
PH-Paramedic
|
Rosenberg DG., Levin E., Lausell A., et al. Feasibility and timing of prehospital administration of reteplase in patients with acute myocardial infarction. J Thromb Thrombolysis 2002; 13(3):147-53. Medline
|
|
III
|
Supportive (Green)
|
70% or greater reduction of ST elevation
|
Patient
|
PH-Paramedic
|
Smalling RW. Pre-hospital reduced-dose fibrinolysis coupled with urgent PCI reduces time to reperfusion and improves angiographic perfusion score compared with prehospital fibrinolysis alone or primary PCI. J Am Coll Card 2007; 50:1612-3. Medline
|
|
III
|
Neutral (Yellow)
|
Safety
|
Patient
|
PH-Paramedic
|
Tatu-Chitoiu G., Oprisan M., Cismara O., Marinescu R., Marinescu A. Streptokinase and enoxaparin in the pre-hospital management of the ST-segment elevation acute myocardial infarction. Rom J Intern Med 2002; 40(1-4):11-25. Medline
|
Morphine
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
Analgesia
|
Process
|
Other
|
Charpentier S, Galinski M, Bounes V, Ricard-Hibon A, El-Khoury C, Elbaz M, et al. Nitrous oxide/oxygen plus acetaminophen versus morphine in ST elevation myocardial infarction: open-label, cluster-randomized, non-inferiority study. Scandinavian J of trauma, resuscitation and Emerg Med 2020; 28(1):36. Medline
|
|
I
|
Supportive (Green)
|
Pain relief
|
Patient
|
ED-MD
|
Everts B., Karlson B., Abdon J., Herlitz J., Hedner T. A comparison of metoprolol and morphine in the treatment of chest pain in patients with suspected acute myocardial infarction - the MEMO study. Journal of Internal Medicine 1999; 245:133-41. Medline
|
|
I
|
Supportive (Green)
|
Pain relief
|
Patient
|
|
Niemi-Murola L., Unkuri J., Hamunen K. Parenteral opioids in emergency medicine - A systematic review of efficacy and safety. Scandinavian journal of pain 2017; 2(4):187-94. Medline
|
|
I
|
Supportive (Green)
|
Pain relief
|
Patient
|
PH-Paramedic
|
Sundstrom BW., Bang A., Karlsson T., Winge K., Lundberg C., Herlitz J. Anxiolytics in patients suffering a suspected acute coronary syndrome: Multi-centre randomised controlled trial in emergency medical service. Int J Cardiol 2013; 168(4):3580-3587. Medline
|
|
II
|
Supportive (Green)
|
1-year mortality
|
Patient
|
|
Puymirat E., Lamhaut L., Bonnet N., Aissaoui N., Henry P., Cayla G., et al. Correlates of pre-hospital morphine use in ST-elevation myocardial infarction patients and its association with in-hospital outcomes and long-term mortality: the FAST-MI (French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction) pr. Eur Heart J 2016; 37(13):1063-71. Medline
|
|
II
|
Supportive (Green)
|
Analgesia
|
Patient
|
PH-Paramedic
|
Ricard-Hibon A., et al. Compliance with a morphine protocol and effect on pain relief in out-of-hospital patients. J Emerg Med 2008; 34:305-10. Medline
|
|
II
|
Neutral (Yellow)
|
30-day major adverse cardiac events
|
Patient
|
Other
|
Fernando H, Nehme Z, Dinh D, et al. Impact of prehospital opioid dose on angiographic and clinical outcomes in acute coronary syndromes. Emerg Med J 2023;40(2):101-7. Medline
|
|
II
|
Neutral (Yellow)
|
Patient characteristics
|
Patient
|
Other
|
Lapostolle F, Van't Hof AW, Hamm CW, Stibbe O, Ecollan P, Collet JP, et al. Morphine and Ticagrelor Interaction in Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction: ATLANTIC-Morphine. American J of Cardiovascular Drugs, Drugs, Devices, and Other Interventions 2019; 19(2):173-83. Medline
|
|
II
|
Opposes (Red)
|
Mortality
|
Patient
|
ED-MD
|
Meine TJ., Roe MT., Chen AY., et al. Association of intravenous morphine use and outcomes in acute coronary syndromes: results from the crusade quality improvement initiative. American Heart Journal 2005; 149(6):1043-9. Medline
|
|
III
|
Supportive (Green)
|
Appropriate administration, complications
|
Process
|
PH-Paramedic
|
Bruns BM., Dieckmann R., Shagoury C., et al. Safety of prehospital therapy with morphine sulfate. Am J Emerg Med 1992; 10(1):53-7. Medline
|
|
III
|
Supportive (Green)
|
Changes in arterial blood pressure, heart rate, respiratory rate and pain.
|
Patient
|
PH-Paramedic
|
Silfvast T., Saarnivaara L. Comparison of alfentanil and morphine in the prehospital treatment with patients with acute ischaemic-type chest pain. Eur J Emerg Med 2001; 8(4)275-8. Medline
|
|
III
|
Supportive (Green)
|
Analgesia
|
Patient
|
PH-Paramedic
|
Weldon ER, Ariano RE, Grierson RA. Comparison of Fentanyl and Morphine in the Prehospital Treatment of Ischemic Type Chest Pain. PEC 2016; 20(1) 45-51. Medline
|
|
III
|
Supportive (Green)
|
Pain relief
|
Patient
|
PH-Paramedic
|
Zedigh C., Alho A., Hammar E., et al. Aspects on the intensity and the relief of pain in the prehospital phase of acute coronary syndrome: Experiences from a randomized clinical trial. Coron Artery Dis 2010; 21(2):113-120. Medline
|
Point of Care Troponin
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
30-day healthcare costs with low major adverse cardiac events
|
Process
|
PH-Paramedic
|
Aarts GWA, Camaro C, Adang EMM, et al. Pre-hospital rule-out of non-ST-segment elevation acute coronary syndrome by a single troponin: final one-year outcomes of the ARTICA randomised trial. Eur Hear J Qual Care Clin Outcomes January 2024. Medline
|
|
I
|
Supportive (Green)
|
30 day healthcare cost
|
Process
|
Other
|
Camaro C, Aarts GWA, Adang EMM, van Hout R, Brok G, Hoare A, et al. Rule-out of non-ST-segment elevation acute coronary syndrome by a single, pre-hospital troponin measurement: a randomized trial. Eur Hear J 2023. Medline
|
|
I
|
Supportive (Green)
|
Prediction of NSTEMI
|
Process
|
PH-Paramedic
|
Demandt JPA, Zelis JM, Koks A, Smits GHJM, van der Harst P, Tonino PAL, Dekker LRC, van Het Veer M, Vlaar PJ. Prehospital risk assessment in patients suspected of non-ST-segment elevation acute coronary syndrome: a systematic review and meta-analysis. BMJ Open 2022; 12(4):e057305. Medline
|
|
II
|
Supportive (Green)
|
Correlation with lab results
|
Process
|
ED-MD
|
Juliano M., Wason C. Comparison of Point-of-Care Versus Laboratory Troponin Testing in an Emergency Department Setting. Mil Med 2017; 182(7) e1938-40. Medline
|
|
II
|
Supportive (Green)
|
Concordance of low risk presentations w/ negative troponins
|
Patient
|
PH-Paramedic
|
Pavlovsky T, Obadia M, Ragot S, Douay B, Casalino E, Ghazali DA. Predictors of Risk Stratification and Value of Point-of-Care of High-Sensitivity Cardiac Troponin-I in EMS Management of Non-ST-Segment Elevation Myocardial Infarction: A Retrospective Study. Prehosp Disaster Med 2022; 37(3):365–72. Medline
|
|
II
|
Supportive (Green)
|
Systematic measurement bias
|
Process
|
|
Sardi AR., Lamoureux JA., Cohn TM., Phillip-Samuel SG. Point-of-Care Testing of Troponin Levels Compared With Automated Laboratory Evaluation: A Reliability Study. Crit Care Nurs Q 2016; 39(4):345-51. Medline
|
|
II
|
Supportive (Green)
|
Hospital diagnosis of NSTEMI
|
Process
|
|
Slagman A., von RJ., Möckel M., Holert F., Meyer ZB., Müller C., et al. Diagnostic performance of a high-sensitive troponin T assay and a troponin T point of care assay in the clinical routine of an Emergency Department: A clinical cohort study. Int J Cardiol 2017; 230:454-60. Medline
|
|
II
|
Supportive (Green)
|
Length of stay
|
Process
|
PH-Paramedic
|
Stopyra JP, Snavely AC, Ashburn NP, Nelson RD, McMurray EL, Hunt MR, et al. EMS blood collection from patients with acute chest pain reduces emergency department length of stay. Am J Emerg Med 2021; 47:248-52. Medline
|
|
II
|
Neutral (Yellow)
|
Predictionof MACE: major adverse cardiac events
|
Process
|
PH-Paramedic
|
Stopyra JP, Snavely AC, Smith LM, David Harris R, Nelson RD, Winslow JE, et al. Prehospital use of a modified HEART Pathway and point-of-care troponin to predict cardiovascular events. PLoS ONE 2020; 15(10). Medline
|
|
II
|
Opposes (Red)
|
Diagnostic prediction
|
Process
|
|
Ter AE., Visser A., Reitsma B., Breedveld R., Wolthuis A. Point-of-care troponin T is inferior to high-sensitivity troponin T for ruling out acute myocardial infarction in the emergency department. European journal of emergency medicine: official journal of the European Society for Emergency Medicine 2016; 23(2):95-101. Medline
|
|
III
|
Supportive (Green)
|
Cost savings
|
Process
|
PH-Paramedic
|
Dawson LP, Nehme E, Nehme Z, Zomer E, Bloom J, et al. Chest Pain Management Using Prehospital Point-of-Care Troponin and Paramedic Risk Assessment. JAMA Intern Med March 2023; 183(3):203-11. Medline
|
|
III
|
Supportive (Green)
|
Prediction of 28 day in-hospital mortality
|
Process
|
PH-Paramedic
|
Martín-Rodríguez F, Sanz-García A, Castro-Portillo E, Delgado-Benito JF, Del Pozo Vegas C, Ortega Rabbione G, et al. Prehospital troponin as a predictor of early clinical deterioration. Eur J Clin Invest 2021; 51(11):e13591. Medline
|
|
III
|
Neutral (Yellow)
|
Accuracy
|
Process
|
|
Prottengeier J., Jess N., Harig F., Gall C., Schmidt J., Birkholz T. Can we rely on out-of-hospital blood samples? A prospective interventional study on the pre-analytical stability of blood samples under prehospital emergency medicine conditions. Scand J T R EM 2017; 25(1):24. Medline
|