2022 Fiscal Year Final Research Report

Usefulness of pre-hospital 12-lead electrocardiogram from K-ACTIVE registry

Research Project

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Project/Area Number	20K08434
Research Category	Grant-in-Aid for Scientific Research (C)
Allocation Type	Multi-year Fund
Section	一般
Review Section	Basic Section 53020:Cardiology-related
Research Institution	Showa University
Principal Investigator	SUZUKI Hiroshi 昭和大学, 医学部, 教授 (90266106)
Co-Investigator(Kenkyū-buntansha)	田村功一横浜市立大学, 医学研究科, 教授 (40285143) 明石嘉浩聖マリアンナ医科大学, 医学部, 教授 (40350615) 阿古潤哉北里大学, 医学部, 教授 (60292744) 海老名俊明横浜市立大学, 附属市民総合医療センター, 准教授 (60336568) 伊苅裕二東海大学, 医学部, 教授 (70271567)
Project Period (FY)	2020-04-01 – 2023-03-31
Keywords	急性心筋梗塞 / レジストリー研究 / 病院前12誘導心電図
Outline of Final Research Achievements	Pre-hospital 12-lead electrocardiogram (PHECG) by emergency medical service personnel at the site of first medical contact (FMC) play important roles in patients with ST-elevation myocardial infarction (STEMI). However, in Japan, PHECG is not routinely performed and physician of first contact is not always cardiologist. 2035 consecutive STEMI patients were analysed from K-ACTIVE registry. Based on presence (+) or absence (-) of PHECG / first contact by cardiologist, patients were divided into 4 groups (+/+, +/-, -/+, -/-). For patient characteristics, there were significant differences in prevalence of dyslipidemia and presence of chest pain. FMC to door time was similar. Door to device time was the shortest in +/+ group (P<0.0001). Crude in-hospital mortality was the highest in -/- group (P<0.0001). PHECG and physician of first contact had significant impacts on door to device time and in-hospital mortality. Continues efforts should be made to improve acute management system of STEMI.
Free Research Field	循環器内科学
Academic Significance and Societal Importance of the Research Achievements	今回の研究により、STEMI患者においてPHECGを救急隊員によって記録する意義が示されたと同時に、AMI患者においては初期対応医師が循環器内科専門医の方がよい可能性が示された。PHECGの記録もしておらず、非循環器内科医師が初期対応をした場合には、AMI発症から再灌流までに時間が遅延し、院内死亡率も高くなることが示された。比較的医療事情がよい神奈川県においても、今回の結果が得られたことにより、より地方においてはその傾向が強くなると考えらえると同時に、今後の医師の働き方改革に関しても重要なデータと考えられる。