Coronary artery diseaseEffectiveness of Prehospital Wireless Transmission of Electrocardiograms to a Cardiologist Via Hand-Held Device for Patients With Acute Myocardial Infarction (from the Timely Intervention in Myocardial Emergency, NorthEast Experience [TIME-NE])
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Study population and clinical definitions
The study was conducted at NorthEast Medical Center in Concord, Cabarrus County, North Carolina, a 457-bed hospital equipped with 2 heart catheterization laboratories. Four interventional cardiologists perform approximately 250 primary percutaneous transluminal coronary angioplasty procedures annually in these laboratories. For the purpose of the study, intervention time was defined as attainment of Thrombolysis In Myocardial Infarction grade 3 flow4 in patients for whom this procedure was
Patient characteristics
Baseline age, gender, and locations of MI of the 192 patients in the intervention and control groups are presented in Table 1. There were no significant differences in age across subgroups, and most patients were men. In addition, most infarcts were in the inferior distribution of the heart, as determined by electrocardiography.
Primary end point
Figure 3 shows the distributions of door-to-reperfusion times in the interventional group compared with the control groups. The peak number of control group patients had
Discussion
In this pilot study of electrocardiographic transmission for patients with STEMI, a statistically significant difference was seen in door-to-reperfusion times if the patient’s prehospital ECG was transmitted directly to a cardiologist compared with those not transmitted. Successful transmission of the ECG resulted in NorthEast Medical Center not only meeting the American College of Cardiology/American Heart Association guideline for door-to-reperfusion time,7 but also exceeding the goal by a
Acknowledgment
We thank the following individuals for their important contributions to this study: Deedee Cromer, Paula Fox, Jim Gardner, Barry Hawthorne, Amanda Thompson, Susan Wilfong, and Beverly Perkins and the participating cardiologists (Thomas F. Trahey, MD, Kevin R. Kruse, MD, David C. Beard, MD, Patrick K. Anonick, MD, Hans H. Lee, MD, Markus D. Scherer, MD, Thomas J. Christopher, MD, and Christopher R. Kroll, MD).
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This study was sponsored by the William T. Morris Foundation, the Duke Endowment, Charlotte, North Carolina, and Welch Allyn, Inc., Skaneateles Falls, New York