The effect of prehospital telecardiology on the mortality and morbidity of ST-segment elevated myocardial infarction patients undergoing primary percutaneous coronary intervention: A cross-sectional study
1Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
2Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
3Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
4Tehran Emergency Medical Service Center, Tehran, Iran
5Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
6Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
Keywords: Mortality, percutaneous coronary intervention, prehospital emergency services, ST elevation myocardial infarction, telemedicine
OBJECTIVES: The sooner the primary percutaneous coronary intervention (PPCI) is performed, the better prognosis is expected in patients with acute myocardial infarction. The objective is to evaluate the effect of prehospital triage based on electrocardiogram (ECG) and telecardiology on the mortality and morbidity of ST-segment elevated myocardial infarction (STEMI) patients undergoing PPCI.
METHODS: This cross-sectional study was conducted based on the data extracted from the hospital information system (HIS) of one general hospital, which had the capability of performing PPCI 24 h a day, 7 days a week. All patients with STEMI who undergone PPCI during 1 year, transferred by emergency medical service (EMS) and their data were registered in the HIS were eligible. Besides the baseline characteristics, first medical contact (FMC)-to-balloon time was recorded. Morbidity based on predischarge left ventricular ejection fraction (LVEF) and mortality based on Global Registry of Acute Cardiac Events (GRACE) score were also recorded. Patients who were referred to the hospital by EMS with prehospital ECG and telecardiology were compared with those without prehospital ECG.
RESULTS: Totally, 298 patients with STEMI were enrolled, of whom 183 patients (61.4%) had prehospital ECG (telecardiology), and 115 patients (38.6%) had not. The means of predischarge LVEF of the patients in the first and the second groups were 40.7 ± 10.4 and 40.6 ± 11.2, respectively (P = 0.946). The mean of the probability of 6-month mortality based on GRACE score in the first group was significantly less than that of the second group (P = 0.004). Analyses of multivariable ordinal logistic regression showed that 6-month mortality severity risk in the second group was 1.5 times more than the first group (95% confidence interval 0.8–2.6), although this difference was not statistically significant (P = 0.199).
CONCLUSIONS: It is likely that prehospital telecardiology, with shortening FMC to balloon time result in reducing probability 6-month mortality in STEMI patients who undergone PPCI. However, the process of telecardiology had no effect on predischarge LVEF in the current study.
How to cite this article: Saberian P, Tavakoli N, Hasani-Sharamin P, Sezavar SH, Dadashi F, Vahidi E. The effect of prehospital telecardiology on the mortality and morbidity of ST-segment elevated myocardial infarction patients undergoing primary percutaneous coronary intervention: A cross-sectional study. Turk J Emerg Med 2020;20:28-34.
PS: concepts, design, definition of intellectual content NT: clinical studies, experimental studies, data acquisition PH-S: definition of intellectual content, literature search, clinical studies SHS: data analysis, statistical analysis, data acquisition FD: manuscript editing, and manuscript review, data acquisition EV: data analysis, statistical analysis, manuscript preparation, manuscript editing, and manuscript review
The authors have no competing interests.
This study was financially supported by a grant received from Tehran EMS Center.
We would like to express our obligations to the prehospital and hospital emergency research center affiliated to the Tehran University of Medical Sciences.