Coronary artery disease
Effectiveness 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])

https://doi.org/10.1016/j.amjcard.2006.05.042Get rights and content

Percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction (STEMI) decreases morbidity and mortality if performed within the first 2 hours of symptom onset. However, the American College of Cardiology/American Heart Association guideline for percutaneous coronary intervention door-to-balloon time (<90 minutes) in patients with STEMI is a infrequently accomplished goal. This study enrolled 277 patients with STEMI who were self-transported or transported by emergency medical services to NorthEast Medical Center for primary percutaneous coronary intervention. This study tested the hypothesis that prehospital wireless transmission of an electrocardiogram to a cardiologist’s hand-held device results in shorter emergency department door-to-reperfusion time. A comparison was made between patients whose electrocardiogram was successfully transmitted during the intervention phase with (1) patients transported by the emergency medical services in the preintervention, (2) patients self-transported in the intervention phase, and (3) patients whose wireless transmission failed in the intervention phase. During the preintervention phase (2001 to 2003), 48 patients were enrolled. During the intervention phase (2003 to 2005), the following patients were enrolled: 101 self-transported patients, 24 patients with successful electrocardiographic transmission, and 19 patients for whom transmission failed. The median door-to-reperfusion time for patients with successful electrocardiographic transmission was 50 minutes, which was significantly shorter than a preintervention time of 101 minutes (p <0.0001), an intervention phase self-transport time of 96 minutes (p <0.0001), and a failed transmission time of 78 minutes (p <0.0001). In conclusion, prehospital wireless electrocardiographic transmission to a cardiologist’s hand-held device significantly decreased emergency department door-to-reperfusion time, thus achieving the American College of Cardiology/American Heart Association guideline for patients with STEMI.

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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

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