The impact of an ECG technician in the emergency room on door-to-ECG an door-to-balloon times in patients with STEMI

Coronary artery disease causes 4000 deaths per year in Portugal, but compliance with recommendations of the European Society of Cardiology for timely assessment and treatment may reduce morbidity and mortality. Delays can be identified and reduced.

To assess the association between the of presence of electrocardiography technicians in a hospital emergency room and compliance with target times recommended by European Society of Cardiology for care of patients with acute myocardial infarction.

Clinical records of patients admitted to an emergency room with acute myocardial infarction with ST-segment elevation or presumed new complete left bundle branch block between 2015 and 2019 were analyzed. Sociodemographic variables, triage status, door-to- electrocardiogram time, and door-to-balloon time data were assessed. The association between presence or absence of an ECG technician and mean time to ECG and catheterization was tested using the Student T-test.

The study sample included 79 patients, with a mean age of 60.4 years ± 11.04. With electrocardiography technicians present, the mean door-to-electrocardiogram time was 6 minutes (1.0 to 40.5 minute 95% CI). In their absence, the mean time was 39 minutes (16 to 113 minutes 95% CI, p<.05). The mean door to-balloon time was 89 (79 to 113 minutes 95% CI) in the presence of a technician, and 148 minutes (110 and 273 minutes 95% CI) in the absence of technician (p<.05). In patients with typical symptoms, the observed door-electrocardiogram time was within the limits of guidelines of European Society of Cardiology in the presence of a technician, with a mean of 5.1 minutes. The mean door-to balloon time was 88.6 minutes. In the absence of a technician, the mean times were higher and outside current guidelines. Infarcts with atypical symptoms resulted in less accurate triage and longer times to electrocardiogram and diagnosis. Care was faster in the presence of an electrocardiography technician.

The presence of electrocardiography technicians significantly reduced door-to-electrocardiogram and door-to-balloon times in patients with myocardial infarction. Reinforcing hospital emergency departments with these professionals could improve the care provided to patients with acute myocardial infarction.