Background: We report the preliminary data from a regional registry on ST-elevation myocardial infarction (STEMI) patients treated with primary angioplasty in Apulia, Italy; the region is covered by a single public health-care service, a single public emergency medical service (EMS), and a single tele-medicine service provider. Methods: Two hundred and ninety-seven consecutive patients with STEMI transferred by regional free public EMS 1-1-8 for primary-PCI were enrolled in the study; 123 underwent pre-hospital electrocardiograms (ECGs) triage by tele-cardiology support and directly referred for primary-PCI, those remaining were just transferred by 1-1-8 ambulances for primary percutaneous coronary intervention (PCI) (diagnosis not based on tele-medicine ECG; already hospitalised patients, emergency-room without tele-medicine support). Time from first ECG diagnostic for STEMI to balloon was recorded; a time-to-balloon <1 h was considered as optimal and patients as timely treated. Results: Mean time-to-balloon with pre-hospital triage and tele-cardiology ECG was significantly shorter (0:41±0:17 vs 1:34±1:11 h, p<0.001, –0:53 h, –56%) and rates of patients timely treated higher (85% vs 35%, p<0.001, +141%), both in patients from the ‘inner’ zone closer to PCI catheterisation laboratories (0:34±0:13 vs 0:54±0:30 h, p<0.001; 96% vs 77%, p<0.01, +30%) and in the ‘outer’ zone (0:52±0:17 vs 1:41±1:14 h, p<0.001; 69% vs 29%, p<0.001, +138%). Results remained significant even after multivariable analysis (odds ratio for time-to-balloon 0.71, 95% confidence interval (CI) 0.63–0.80, p<0.001; 1.39, 95% CI 1.25–1.55, p<0.001, for timely primary-PCI). Conclusions: Pre-hospital triage with tele-cardiology ECG in an EMS registry from an area with more than one and a half million inhabitants was associated with shorter time-to-balloon and higher rates of timely treated patients, even in ‘rural’ areas.

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