To the Editor:
We have read with great interest the recent article “12-Lead Electrocardiograms Acquired and Transmitted by Emergency Medical Technicians are of Diagnostic Quality and Positively Impact Patient Care” by Kotelnik, et al. Reference Kotelnik, Pesce and Masterton1 Delays in prehospital access to coronary angiography laboratories in patients with suspected ST segment elevation myocardial infarction (STEMI) are an important factor that changes mortality. Reference Ibánez, James and Agewall2 I think this study, which investigates the usefulness of a system that will reduce prehospital delays in STEMI patients, is valuable. However, we would like to share some of our thoughts on the study.
Although it was reported that there were 665 patients whose data were investigated in the study and there were 543 patients suitable to evaluate electrocardiograms (ECGs), the presentation of the data of 557 patients whose prehospital time records were reached in Table 1 Reference Kotelnik, Pesce and Masterton1 causes confusion. Again in Table 1, Reference Kotelnik, Pesce and Masterton1 prehospital durations of STEMI patients who were correctly diagnosed and missed are given as numerical values, and it is not stated whether there is a statistical difference between these values. In addition, the time between the first medical contact (FMC) and the wig to primary coronary intervention (PCI) is not included among the time records given in Table 1. It has been reported in previous studies that the time between FMC and PCI is directly related to mortality. Reference Żurowska-Wolak, Piekos, Jąkała and Mikos3,Reference Kawakami, Tahara and Noguchi4 Therefore, I think the time between FMC and PCI should be reported in the study.
It is recommended that the first ECG should be taken within 10 minutes after the first contact in patients with suspected STEMI. Reference Diercks, Peacock and Hiestand5 The average time spent on imaging in the study was reported as 18 minutes. In a system that aims to reduce prehospital delays in STEMI patients, we think that the reasons for this delay seen in the first imaging should be reported and discussed.
We think this important study on ECG evaluation in prehospital process will contribute to the literature. We are sure that it will remain in place for a long time, since it is a simple and reliable diagnostic test in the diagnosis of STEMI and the prehospital staff are successful.
Conflicts of interest