Effect of Prehospital Digital Electrocardiogram Transmission on Revascularization Delays and Mortality in ST-Elevation Myocardial Infarction Patients: Systematic Review and Meta-Analysis

Overview

Journal CJC Open

Specialty Cardiology & Vascular Diseases

Date 2024 Nov 11

PMID 39525334

Authors

Rachel N Moxham

Marc-Andre dEntremont

Hassan Mir

J D Schwalm

Madhu K Natarajan

Sanjit S Jolly

Affiliations

Soon will be listed here.

Abstract

Background: Prehospital transmission of the 12-lead electrocardiogram (ECG) to the interventional cardiologist has become the standard of care in many ST-elevation myocardial infarction (STEMI) networks but has not been adopted universally. In this systematic review and meta-analysis, we assess the effect of prehospital digital ECG transmission in STEMI patients on door-to-device times, first medical contact-to-device times, and mortality.

Methods: We performed a systematic review of all English-language studies in MEDLINE, Embase, and CENTRAL (from inception to July 24, 2023), comparing the effect of prehospital digital ECG transmission to that of no ECG transmission in STEMI patients. We performed a random-effects meta-analysis.

Results: We included 17 observational studies totalling 4306 patients. Door-to-device times were reduced by 33.3 minutes in patients with prehospital digital ECG transmission (95% confidence intervals [CIs] -50.5, -16.2 minutes; < 0.001; I 99%). First-medical-contact-to-device time also was reduced with prehospital digital ECG transmission (mean difference, -24.7 minutes; 95% CI -37.1, -12.3 minutes; < 0.001; I 96%). Prehospital digital ECG transmissions was associated with a 47% reduction in mortality compared to no prehospital digital ECG transmission (117 of 1322 (8.9%) vs 181 of 1322 (13.7%), odds ratio 0.53, 95% CI 0.40, 0.69; < 0.001; I = 0%).

Conclusions: Prehospital ECG transmission in STEMI patients, coupled with a systems of care reduced door-to-device times, first-medical-contact-to-device times, and mortality. STEMI networks should consider these findings to advocate for prehospital ECG transmission within their systems of care.

Study Registration: CRD42024509271 (PROSPERO).

References

Roswell R, Greet B, Parikh P, Mignatti A, Freese J, Lobach I . From door-to-balloon time to contact-to-device time: predictors of achieving target times in patients with ST-elevation myocardial infarction. Clin Cardiol. 2014; 37(7):389-94. PMC: 6649358. DOI: 10.1002/clc.22278. View

Chao C, Chen Y, Shih C, Hou S, Seethala R, Aisiku I . Smartphone transmission of electrocardiography images to reduce time of cardiac catheterization laboratory activation. J Chin Med Assoc. 2017; 81(6):505-510. DOI: 10.1016/j.jcma.2017.11.009. View

Ong M, Wong A, Meng Seet C, Teo S, Lim B, Ong P . Nationwide improvement of door-to-balloon times in patients with acute ST-segment elevation myocardial infarction requiring primary percutaneous coronary intervention with out-of-hospital 12-lead ECG recording and transmission. Ann Emerg Med. 2012; 61(3):339-47. DOI: 10.1016/j.annemergmed.2012.08.020. View

Adams G, Campbell P, Adams J, Strauss D, Wall K, Patterson J . 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]). Am J Cardiol. 2006; 98(9):1160-4. DOI: 10.1016/j.amjcard.2006.05.042. View

Carstensen S, Nelson G, Hansen P, Macken L, Irons S, Flynn M . Field triage to primary angioplasty combined with emergency department bypass reduces treatment delays and is associated with improved outcome. Eur Heart J. 2007; 28(19):2313-9. DOI: 10.1093/eurheartj/ehm306. View

Park K, Park J, Cho Y, Park T, Kim M, Yang T . Community-Based Pre-Hospital Electrocardiogram Transmission Program for Reducing Systemic Time Delay in Acute ST-Segment Elevation Myocardial Infarction. Korean Circ J. 2020; 50(8):709-719. PMC: 7390714. DOI: 10.4070/kcj.2019.0337. View

Arinaga T, Suematsu Y, Nakamura A, Imaizumi T, Hanaoka Y, Takagi T . The Effectiveness of Mobile Cloud 12-Lead Electrocardiogram Transmission System in Patients with ST-Segment Elevation Myocardial Infarction. Medicina (Kaunas). 2022; 58(2). PMC: 8876768. DOI: 10.3390/medicina58020247. View

Martinoni A, De Servi S, Boschetti E, Zanini R, Palmerini T, Politi A . Importance and limits of pre-hospital electrocardiogram in patients with ST elevation myocardial infarction undergoing percutaneous coronary angioplasty. Eur J Cardiovasc Prev Rehabil. 2011; 18(3):526-32. DOI: 10.1177/1741826710389395. View

Dalby M, Bouzamondo A, Lechat P, Montalescot G . Transfer for primary angioplasty versus immediate thrombolysis in acute myocardial infarction: a meta-analysis. Circulation. 2003; 108(15):1809-14. DOI: 10.1161/01.CIR.0000091088.63921.8C. View

10.

Hutchison A, Malaiapan Y, Jarvie I, Barger B, Watkins E, Braitberg G . Prehospital 12-lead ECG to triage ST-elevation myocardial infarction and emergency department activation of the infarct team significantly improves door-to-balloon times: ambulance Victoria and MonashHEART Acute Myocardial Infarction (MonAMI).... Circ Cardiovasc Interv. 2009; 2(6):528-34. DOI: 10.1161/CIRCINTERVENTIONS.109.892372. View

11.

Stroup D, Berlin J, Morton S, Olkin I, Williamson G, Rennie D . Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000; 283(15):2008-12. DOI: 10.1001/jama.283.15.2008. View

12.

Sakai T, Nishiyama O, Onodera M, Matsuda S, Wakisawa S, Nakamura M . Predictive ability and efficacy for shortening door-to-balloon time of a new prehospital electrocardiogram-transmission flow chart in patients with ST-elevation myocardial infarction - Results of the CASSIOPEIA study. J Cardiol. 2018; 72(4):335-342. DOI: 10.1016/j.jjcc.2018.03.011. View

13.

Sanchez-Ross M, Oghlakian G, Maher J, Patel B, Mazza V, Hom D . The STAT-MI (ST-Segment Analysis Using Wireless Technology in Acute Myocardial Infarction) trial improves outcomes. JACC Cardiovasc Interv. 2011; 4(2):222-7. DOI: 10.1016/j.jcin.2010.11.007. View

14.

Kawakami S, Tahara Y, Noguchi T, Yagi N, Kataoka Y, Asaumi Y . Time to Reperfusion in ST-Segment Elevation Myocardial Infarction Patients With vs. Without Pre-Hospital Mobile Telemedicine 12-Lead Electrocardiogram Transmission. Circ J. 2016; 80(7):1624-33. DOI: 10.1253/circj.CJ-15-1322. View

15.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010; 8(5):336-41. DOI: 10.1016/j.ijsu.2010.02.007. View

16.

Fazel R, Joseph T, Sankardas M, Pinto D, Yeh R, Kumbhani D . Comparison of Reperfusion Strategies for ST-Segment-Elevation Myocardial Infarction: A Multivariate Network Meta-analysis. J Am Heart Assoc. 2020; 9(12):e015186. PMC: 7429064. DOI: 10.1161/JAHA.119.015186. View

17.

Sejersten M, Sillesen M, Hansen P, Nielsen S, Nielsen H, Trautner S . Effect on treatment delay of prehospital teletransmission of 12-lead electrocardiogram to a cardiologist for immediate triage and direct referral of patients with ST-segment elevation acute myocardial infarction to primary percutaneous coronary.... Am J Cardiol. 2008; 101(7):941-6. DOI: 10.1016/j.amjcard.2007.11.038. View

18.

Nam J, Caners K, Bowen J, Welsford M, OReilly D . Systematic review and meta-analysis of the benefits of out-of-hospital 12-lead ECG and advance notification in ST-segment elevation myocardial infarction patients. Ann Emerg Med. 2013; 64(2):176-86, 186.e1-9. DOI: 10.1016/j.annemergmed.2013.11.016. View

19.

Brunetti N, DellAnno A, Martone A, Natale E, Rizzon B, Di Cillo O . Prehospital ECG transmission results in shorter door-to-wire time for STEMI patients in a remote mountainous region. Am J Emerg Med. 2019; 38(2):252-257. DOI: 10.1016/j.ajem.2019.04.046. View

20.

Al-Zaiti S, Shusterman V, Carey M . Novel technical solutions for wireless ECG transmission & analysis in the age of the internet cloud. J Electrocardiol. 2013; 46(6):540-5. DOI: 10.1016/j.jelectrocard.2013.07.002. View