Paced Electrocardiogram Requiring Fast Emergent Coronary Therapy (PERFECT) Study

Diagnosis of Acute Coronary Occlusion in patients with a Ventricular Paced Rhythm

Grant ID: EMTR-154R25-2016

Project Summary

The aim of this study is to assess the performance characteristics of the modified Sgarbossa criteria for diagnosis of ACO in VPR. This is a multi-centre international trial. The number of patients presenting to our Emergency Departments with pacemakers continues to increase. Investigating whether such patients are having a heart attack is challenging. For patients without pacemakers, ECG criteria can be used to identify a subset of patients who are having a heart attack. However, for patients with pacemakers, there are no accurate electrocardiograph (ECG) criteria to diagnose heart attacks.

This research has the potential to identify AMI in patients with VPR and improve Emergency Medical care in a time critical management decision. As such, it will develop emergency medicine research in Queensland and internationally by improving patients care and outcomes. It also will develop education and knowledge that will be recognised worldwide.

Smith et al have derived criteria (modified Sgarbossa’s criteria) for diagnosing heart attack using ECG characteristics in patients with a known abnormal ECG trace. This study will assess the accuracy of the Sgarbossa’s criteria in patients with pacemakers. We will collect data on demographics and ECG criteria for patients with pacemakers who present to the Emergency Department at the Royal Brisbane and Women’s Hospital with potential heart attack. We will then examine the results from the patient’s angiogram. The data will combined with data from multiple sites around the world to help validate ECG criteria for diagnosing heart attack in patients with pacemakers.

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Outcomes

While preliminary analyses have been conducted, international recruitment is ongoing.

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IMPACT

There are currently no guidelines or pathways to identify ACO in patients with a ventricular paced rhythm. The data obtained from this study will inform the creation of guidelines as well as new diagnostic tool for diagnosing ACO in patients with ventricular paced rhythms.

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Leveraged Funds

- In-kind: $11,295

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Dissemination

Mitchell, G.J., Dodd, K., Zvosec, D.L., Chen, E., Hart, M.A., Marshall, J., Smith, A.A., Suna, J., Cullen, L. and Smith, S.W., 2018. P103: Performance characteristics of the modified Sgarbossa criteria for diagnosis of acute coronary occlusion in emergency department patients with ventricular paced rhythm and symptoms of acute coronary syndrome. Canadian Journal of Emergency Medicine, 20(S1), pp.S93-S93.

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