Role of rapid 12-lead electrocardiogram in triage initiatives for ST-elevation myocardial infarction patients self-presenting in emergency departments: a systematic review and meta-analysis

Aims To assess the impact of triage initiatives for rapid 12-lead electrocardiogram (ECG) acquisition on door-to-ECG (DTE), door-to-balloon (DTB), length of stay (LOS), and in-hospital mortality for self-presenting emergency department (ED) patients with ST-elevation myocardial infarction. Methods and results This systematic review encompassed cohort studies, controlled trials, one-group pre-test-post-test studies, interventional, observational, and randomized controlled trials assessing rapid acquisition of ECG for patients above 18 years experiencing symptoms of ST-elevation myocardial infarction in ED. Data from seven databases underwent screening, extraction, and quality appraisals by two independent reviewers. Employing a random-effects model, meta-analyses were conducted for primary outcomes: DTE, DTB, LOS, and in-hospital mortality. Subgroup analyses and meta-regression were performed for meta-analyses with over 10 studies. This review included 25 studies with 19 475 ST-elevation myocardial infarction patients. All were cohort studies with acceptable evidence quality. Our findings revealed enhanced triage initiatives for ECG related to significant reductions in DTE (MD -6.45 min, P < 0.001) and DTB (MD -24.40 min, P < 0.001) times. More institutions met benchmarked goals for DTE (MD 22.2%, P < 0.001) and DTB (MD 15.6%, P < 0.001) times. Improvements reported in LOS and in-hospital mortality were not significant. Subgroup and meta-regression analyses revealed significant differences in DTE times, but not in DTB times. Conclusion Positive impacts of such initiatives on ST-elevation myocardial infarction patient outcomes offer institutions opportunities to improve triage processes and training. Future research should focus on extended follow-up and larger sample sizes for a comprehensive understanding of sustained impacts. Registration PROSPERO: CRD42023472392.