Problem: ST-segment elevation in acute myocardial infarction should be treated with primary percutaneous coronary intervention or fibrinolytic therapy as soon as possible because the survival benefit documented for these therapies decline rapidly with increasing time delays. Current guidelines accept between 60 and 90 minutes delays from arrival to hospital until initiation reperfusion therapies but audits have found the "real world" time delay exceedingly longer. When primary PCI is the preferred reperfusion strategy, additional time delays may be introduced to arrange secondary transportation from the primary receiving hospital to the tertiary invasive center. The recently reported DANAMI 2 trial found a median 55 minutes delay in the primary hospital emergency room for confirmation of the Acute myocardial infarction (AMI) diagnosis by electrocardiogram (ECG) and to free a physician for patient escort. Solutions: We developed a new system for triage of patients with acute chest pain. Patients suspected of acute coronary syndromes have a 12-lead ECG (LifePak12 by Medtronic) recorded by the ambulance staff and transmitted digitally via the GSM mobile phone net to the Heart Station and forwarded to a hand-held computer carried around the clock by the attending cardiologist. Results: During the initial 12-month period a total of 156 ECGs were transmitted resulting in 24 patients being diverted for primary PCI. The median time from the 911 call until the ECG was obtained was 17 minutes (range, 723). The time from ECG acquisition in the patient home to PCI procedure ranged from 28 to 72 min. (median 46min.). Compared to historic data from the DANAMI 2 trial (n = 24) immediately preceding the telemedicine era our door-to-balloon time was reduced by greater than1 hour. Door-to-balloon time was reduced to 26 minutes (range, 1245) compared to 94 minutes (range, 56147) in preceding time period; P = .02. Subsequently, 80% of Danish ambulances now have tele-ECG equipment, and 5 counties have started prehospital triage based on digitally transmitted ECGs that directly connect to the attending cardiologist or to the local CCU. Conclusions: R Transmitting 12-lead ECGs from the community directly to attending cardiologist should become routine. Time to reperfusion in ST elevation AMI will decrease and subsequently result in a decreased mortality and morbidity in patients with ST-segment elevation AMI.
|Tidsskrift||Journal of Electrocardiology|
|Status||Udgivet - 1 okt. 2004|