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Prehospital 12-lead ECG and outcomes in acute coronary syndrome

Timothy Driscoll Orcid Logo, Sarah Black, Glenn Davies, Chris P Gale, Lucia Gavalova, Mary Halter, Chelsey Hughes, Scott Munro, Nigel Rees, Andy Rosser Orcid Logo, Helen Snooks Orcid Logo, Alan Watkins Orcid Logo, Clive Weston Orcid Logo, Tom Quinn

Heart, Pages: heartjnl - 2025

Swansea University Authors: Timothy Driscoll Orcid Logo, Helen Snooks Orcid Logo, Alan Watkins Orcid Logo, Clive Weston Orcid Logo

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DOI (Published version): 10.1136/heartjnl-2025-325780

Abstract

Importance/background The 12-lead ECG is recommended in clinical guidelines for prehospital assessment of patients with suspected acute coronary syndrome (ACS) presenting to Emergency Medical Services (EMS).Objectives To determine prehospital ECG (PHECG) utilisation since UK national rollout of prim...

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Published in: Heart
ISSN: 1355-6037 1468-201X
Published: BMJ 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa70160
first_indexed 2025-08-11T08:30:50Z
last_indexed 2026-01-28T05:33:40Z
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2026-01-27T11:33:38.2181689</datestamp><bib-version>v2</bib-version><id>70160</id><entry>2025-08-11</entry><title>Prehospital 12-lead ECG and outcomes in acute coronary syndrome</title><swanseaauthors><author><sid>2be5c329c44d14550ceac4934fcb409e</sid><ORCID>0000-0001-9879-2509</ORCID><firstname>Timothy</firstname><surname>Driscoll</surname><name>Timothy Driscoll</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>ab23c5e0111b88427a155a1f495861d9</sid><ORCID>0000-0003-0173-8843</ORCID><firstname>Helen</firstname><surname>Snooks</surname><name>Helen Snooks</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>81fc05c9333d9df41b041157437bcc2f</sid><ORCID>0000-0003-3804-1943</ORCID><firstname>Alan</firstname><surname>Watkins</surname><name>Alan Watkins</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>df85e4e0e139d0f46eb683174eba98a9</sid><ORCID>0000-0002-8995-8199</ORCID><firstname>Clive</firstname><surname>Weston</surname><name>Clive Weston</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2025-08-11</date><deptcode>MEDS</deptcode><abstract>Importance/background The 12-lead ECG is recommended in clinical guidelines for prehospital assessment of patients with suspected acute coronary syndrome (ACS) presenting to Emergency Medical Services (EMS).Objectives To determine prehospital ECG (PHECG) utilisation since UK national rollout of primary percutaneous coronary intervention, and whether this is associated with clinical outcomes in patients with ACS.Design Population-based, linked cohort study using Myocardial Ischaemia National Audit Project data from 1 January 2010 to 31 December 2017, related to patients with ACS conveyed by the EMS to hospital in England and Wales.Exposure PHECG administration.Outcomes Proportion of patients where PHECG was recorded, 30-day and 1&#x2009;year all-cause mortality, use of reperfusion.Results Of 330&#x2009;713 eligible patients transferred by EMS, 263&#x2009;420 patients (79.7%) had PHECG recorded, steadily increasing from 74.2% in 2010 to 85.0% in 2017. Patients who received PHECG were generally younger than those who did not (median age: 70 years vs 75 years), less likely to be female (32.8% vs 41.9%) or to have comorbidities such as diabetes (20.8% vs 24.7%) or peripheral vascular disease (4.1% vs 4.8%). Patients who received PHECG had lower mortality at 30 days (7.1% vs 10.9%), with adjusted OR 0.77 (95% CI 0.75 to 0.80), and at 1 year (14.2% vs 23.2%), with adjusted OR 0.69 (95% CI 0.68 to 0.71). Adjustment accommodated demographic characteristics, comorbidities and medical history. Reperfusion was more frequent in patients with ST-elevation myocardial infarction (STEMI) receiving PHECG (84.5% vs 54.7%) with adjusted OR 4.37 (95% CI 4.20 to 4.54), with similar adjustment.Conclusions Use of PHECG by EMS for patients with ACS is associated with lower short-term mortality and higher odds of receiving reperfusion for STEMI patients. Administration of PHECG increased steadily over time, but at the end of the study, still 15% of eligible patients did not receive a PHECG.</abstract><type>Journal Article</type><journal>Heart</journal><volume>0</volume><journalNumber/><paginationStart>heartjnl</paginationStart><paginationEnd>2025</paginationEnd><publisher>BMJ</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>1355-6037</issnPrint><issnElectronic>1468-201X</issnElectronic><keywords/><publishedDay>10</publishedDay><publishedMonth>9</publishedMonth><publishedYear>2025</publishedYear><publishedDate>2025-09-10</publishedDate><doi>10.1136/heartjnl-2025-325780</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>SU Library paid the OA fee (TA Institutional Deal)</apcterm><funders>British Heart Foundation - PG/18/13/33558</funders><projectreference/><lastEdited>2026-01-27T11:33:38.2181689</lastEdited><Created>2025-08-11T09:24:59.1391941</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Timothy</firstname><surname>Driscoll</surname><orcid>0000-0001-9879-2509</orcid><order>1</order></author><author><firstname>Sarah</firstname><surname>Black</surname><order>2</order></author><author><firstname>Glenn</firstname><surname>Davies</surname><order>3</order></author><author><firstname>Chris P</firstname><surname>Gale</surname><order>4</order></author><author><firstname>Lucia</firstname><surname>Gavalova</surname><order>5</order></author><author><firstname>Mary</firstname><surname>Halter</surname><order>6</order></author><author><firstname>Chelsey</firstname><surname>Hughes</surname><order>7</order></author><author><firstname>Scott</firstname><surname>Munro</surname><order>8</order></author><author><firstname>Nigel</firstname><surname>Rees</surname><order>9</order></author><author><firstname>Andy</firstname><surname>Rosser</surname><orcid>0000-0002-5477-4269</orcid><order>10</order></author><author><firstname>Helen</firstname><surname>Snooks</surname><orcid>0000-0003-0173-8843</orcid><order>11</order></author><author><firstname>Alan</firstname><surname>Watkins</surname><orcid>0000-0003-3804-1943</orcid><order>12</order></author><author><firstname>Clive</firstname><surname>Weston</surname><orcid>0000-0002-8995-8199</orcid><order>13</order></author><author><firstname>Tom</firstname><surname>Quinn</surname><order>14</order></author></authors><documents><document><filename>70160__35195__960643fc9aca4105b18e1f5c825af217.pdf</filename><originalFilename>70160.VoR.pdf</originalFilename><uploaded>2025-09-29T14:57:50.6873115</uploaded><type>Output</type><contentLength>507744</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; Author(s) (or their employer(s)) 2025. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>https://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2026-01-27T11:33:38.2181689 v2 70160 2025-08-11 Prehospital 12-lead ECG and outcomes in acute coronary syndrome 2be5c329c44d14550ceac4934fcb409e 0000-0001-9879-2509 Timothy Driscoll Timothy Driscoll true false ab23c5e0111b88427a155a1f495861d9 0000-0003-0173-8843 Helen Snooks Helen Snooks true false 81fc05c9333d9df41b041157437bcc2f 0000-0003-3804-1943 Alan Watkins Alan Watkins true false df85e4e0e139d0f46eb683174eba98a9 0000-0002-8995-8199 Clive Weston Clive Weston true false 2025-08-11 MEDS Importance/background The 12-lead ECG is recommended in clinical guidelines for prehospital assessment of patients with suspected acute coronary syndrome (ACS) presenting to Emergency Medical Services (EMS).Objectives To determine prehospital ECG (PHECG) utilisation since UK national rollout of primary percutaneous coronary intervention, and whether this is associated with clinical outcomes in patients with ACS.Design Population-based, linked cohort study using Myocardial Ischaemia National Audit Project data from 1 January 2010 to 31 December 2017, related to patients with ACS conveyed by the EMS to hospital in England and Wales.Exposure PHECG administration.Outcomes Proportion of patients where PHECG was recorded, 30-day and 1 year all-cause mortality, use of reperfusion.Results Of 330 713 eligible patients transferred by EMS, 263 420 patients (79.7%) had PHECG recorded, steadily increasing from 74.2% in 2010 to 85.0% in 2017. Patients who received PHECG were generally younger than those who did not (median age: 70 years vs 75 years), less likely to be female (32.8% vs 41.9%) or to have comorbidities such as diabetes (20.8% vs 24.7%) or peripheral vascular disease (4.1% vs 4.8%). Patients who received PHECG had lower mortality at 30 days (7.1% vs 10.9%), with adjusted OR 0.77 (95% CI 0.75 to 0.80), and at 1 year (14.2% vs 23.2%), with adjusted OR 0.69 (95% CI 0.68 to 0.71). Adjustment accommodated demographic characteristics, comorbidities and medical history. Reperfusion was more frequent in patients with ST-elevation myocardial infarction (STEMI) receiving PHECG (84.5% vs 54.7%) with adjusted OR 4.37 (95% CI 4.20 to 4.54), with similar adjustment.Conclusions Use of PHECG by EMS for patients with ACS is associated with lower short-term mortality and higher odds of receiving reperfusion for STEMI patients. Administration of PHECG increased steadily over time, but at the end of the study, still 15% of eligible patients did not receive a PHECG. Journal Article Heart 0 heartjnl 2025 BMJ 1355-6037 1468-201X 10 9 2025 2025-09-10 10.1136/heartjnl-2025-325780 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University SU Library paid the OA fee (TA Institutional Deal) British Heart Foundation - PG/18/13/33558 2026-01-27T11:33:38.2181689 2025-08-11T09:24:59.1391941 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Timothy Driscoll 0000-0001-9879-2509 1 Sarah Black 2 Glenn Davies 3 Chris P Gale 4 Lucia Gavalova 5 Mary Halter 6 Chelsey Hughes 7 Scott Munro 8 Nigel Rees 9 Andy Rosser 0000-0002-5477-4269 10 Helen Snooks 0000-0003-0173-8843 11 Alan Watkins 0000-0003-3804-1943 12 Clive Weston 0000-0002-8995-8199 13 Tom Quinn 14 70160__35195__960643fc9aca4105b18e1f5c825af217.pdf 70160.VoR.pdf 2025-09-29T14:57:50.6873115 Output 507744 application/pdf Version of Record true © Author(s) (or their employer(s)) 2025. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license. true eng https://creativecommons.org/licenses/by/4.0/
title Prehospital 12-lead ECG and outcomes in acute coronary syndrome
spellingShingle Prehospital 12-lead ECG and outcomes in acute coronary syndrome
Timothy Driscoll
Helen Snooks
Alan Watkins
Clive Weston
title_short Prehospital 12-lead ECG and outcomes in acute coronary syndrome
title_full Prehospital 12-lead ECG and outcomes in acute coronary syndrome
title_fullStr Prehospital 12-lead ECG and outcomes in acute coronary syndrome
title_full_unstemmed Prehospital 12-lead ECG and outcomes in acute coronary syndrome
title_sort Prehospital 12-lead ECG and outcomes in acute coronary syndrome
author_id_str_mv 2be5c329c44d14550ceac4934fcb409e
ab23c5e0111b88427a155a1f495861d9
81fc05c9333d9df41b041157437bcc2f
df85e4e0e139d0f46eb683174eba98a9
author_id_fullname_str_mv 2be5c329c44d14550ceac4934fcb409e_***_Timothy Driscoll
ab23c5e0111b88427a155a1f495861d9_***_Helen Snooks
81fc05c9333d9df41b041157437bcc2f_***_Alan Watkins
df85e4e0e139d0f46eb683174eba98a9_***_Clive Weston
author Timothy Driscoll
Helen Snooks
Alan Watkins
Clive Weston
author2 Timothy Driscoll
Sarah Black
Glenn Davies
Chris P Gale
Lucia Gavalova
Mary Halter
Chelsey Hughes
Scott Munro
Nigel Rees
Andy Rosser
Helen Snooks
Alan Watkins
Clive Weston
Tom Quinn
format Journal article
container_title Heart
container_volume 0
container_start_page heartjnl
publishDate 2025
institution Swansea University
issn 1355-6037
1468-201X
doi_str_mv 10.1136/heartjnl-2025-325780
publisher BMJ
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description Importance/background The 12-lead ECG is recommended in clinical guidelines for prehospital assessment of patients with suspected acute coronary syndrome (ACS) presenting to Emergency Medical Services (EMS).Objectives To determine prehospital ECG (PHECG) utilisation since UK national rollout of primary percutaneous coronary intervention, and whether this is associated with clinical outcomes in patients with ACS.Design Population-based, linked cohort study using Myocardial Ischaemia National Audit Project data from 1 January 2010 to 31 December 2017, related to patients with ACS conveyed by the EMS to hospital in England and Wales.Exposure PHECG administration.Outcomes Proportion of patients where PHECG was recorded, 30-day and 1 year all-cause mortality, use of reperfusion.Results Of 330 713 eligible patients transferred by EMS, 263 420 patients (79.7%) had PHECG recorded, steadily increasing from 74.2% in 2010 to 85.0% in 2017. Patients who received PHECG were generally younger than those who did not (median age: 70 years vs 75 years), less likely to be female (32.8% vs 41.9%) or to have comorbidities such as diabetes (20.8% vs 24.7%) or peripheral vascular disease (4.1% vs 4.8%). Patients who received PHECG had lower mortality at 30 days (7.1% vs 10.9%), with adjusted OR 0.77 (95% CI 0.75 to 0.80), and at 1 year (14.2% vs 23.2%), with adjusted OR 0.69 (95% CI 0.68 to 0.71). Adjustment accommodated demographic characteristics, comorbidities and medical history. Reperfusion was more frequent in patients with ST-elevation myocardial infarction (STEMI) receiving PHECG (84.5% vs 54.7%) with adjusted OR 4.37 (95% CI 4.20 to 4.54), with similar adjustment.Conclusions Use of PHECG by EMS for patients with ACS is associated with lower short-term mortality and higher odds of receiving reperfusion for STEMI patients. Administration of PHECG increased steadily over time, but at the end of the study, still 15% of eligible patients did not receive a PHECG.
published_date 2025-09-10T05:32:08Z
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