The transtelephonic electrocardiogram-based triage is an independent predictor of decreased hospital mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

Abstract

Introduction The transtelephonic electrocardiogram has been shown to have a great value in the management of out-of-hospital chest pain emergencies. In our previous study it not only improved the pre-hospital medical therapy and time to intervention, but also the in-hospital mortality in ST-segment elevation myocardial infarction. It was hypothesised that the higher in-hospital survival rate could be due to improved transtelephonic electrocardiogram-based pre-hospital management (electrocardiogram interpretation and teleconsultation) and consequently, better coronary perfusion of patients at the time of hospital admission. To test this hypothesis, our database of ST-segment elevation myocardial infarction patients was evaluated retrospectively for predictors (including transtelephonic electrocardiogram) that may influence in-hospital survival. Methods and results The ST-segment elevation myocardial infarction patients were divided into two groups, namely (a) hospital death patients ( n = 49) and (b) hospital survivors (control, n = 726). Regarding pre-hospital medical management, the transtelephonic electrocardiogram-based triage (odds ratio 0.48, confidence interval 0.25–0.92, p = 0.0261) and the administration of optimal pre-hospital medical therapy (acetylsalicylic acid and/or clopidogrel and glycoprotein IIb/IIIa inhibitor) were the most important independent predictors for a decreased risk in our model. At the same time, age, acute heart failure (Killip class >2), successful pre-hospital resuscitation and total occlusion of the infarct-related coronary artery before percutaneous coronary intervention were the most important independent predictors for an increased risk of in-hospital mortality. Discussion In ST-segment elevation myocardial infarction patients, (a) an early transtelephonic electrocardiogram-based teleconsultation and triage, (b) optimal pre-hospital antithrombotic medical therapy and (c) the patency and better perfusion of the infarct-related coronary artery on hospital admission are important predictors of a lower in-hospital mortality rate.

Predictors of Hospital Mortality in Patients with Acute Coronary Syndrome Complicated by Cardiogenic Shock

“…In previous studies, TTECG-based consultation with cardiologists contributed to bringing about a significantly lower in-hospital mortality rate of STEMI patients [ 5 , 6 ]. Moreover, TTECG-based triage has been identified as an independent predictor of decreased hospital mortality [ 19 ]. This result was somewhat unexpected, and it was presumed that the benefits related to TTECG-based consultation were associated with more favourable pre-hospital medical therapy, as well as shortened transport and PCI procedural times.…”

“…Moreover, other important time intervals (door-to-sheath insertion and door-to-balloon time) have also been found to be reduced by TTECG, as shown in both the present study and previous investigations [ 6 ]). Finally, yet another important benefit of TTECG-based triage could be that prehospital pharmacotherapy is discussed by the emergency personnel and the PCI centre staff via teleconsultation [ 6 , 19 ].…”

A Medico-Socio-Economic Analysis of TeleEKG in Ivory Coast

“…The vital role of the EKG in the provision of care has already been well established for emergency departments, mobile emergency units, and intensive care or general medicine departments, and the management of myocardial infarction is defined by the imperative use of the EKG as early as possible. [19][20][21][22][23][24][25][26][27][28] These indications explain its availability in all departments in most hospitals in developed countries. 19,20,29 However, this is not the case in Africa, where EKGs are most often only performed in specialized cardiology departments.…”

Implementation of a full-scale prehospital telemedicine system: evaluation of the process and systemic effects in a pre–post intervention study

“… 8 9 By using the telemedical procedure, in-hospital mortality in patients with STEMI can be reduced. 10 However, widespread use is lacking. Besides acute coronary syndromes, telemedical interventions in the prehospital phase and scientific data are rare, so that many projects are not transferred into routine care after cessation of project financing.…”