Abstract 14281: Door-To-Balloon Time Decreases With Pre-Hospital Wireless Electrocardiogram Transmission in Patients with ST-Segment Elevation Myocardial Infarction
Background: Current ACC/AHA guidelines recommend a door-to-balloon time (D2B) of < 90 minutes in patients with ST-segment elevation myocardial infarction (STEMI). In April 2010, the Fire Department of New York City (FDNY) implemented wireless transmission of the electrocardiogram (ECG) from the field to receiving hospitals.
Hypothesis: We assessed the hypothesis that the wireless transmission of pre-hospital ECGs in STEMI patients would effectively reduce D2B in a highly populated metropolitan area.
Methods: We evaluated 99 consecutive patients from 01/08/2009 to 04/06/2011 who presented to the Bellevue Hospital ER with evidence of STEMI and underwent primary PCI. Patients with hemodynamic instability and complex coronary anatomy were excluded in accordance with regulatory standards. The baseline characteristics, D2B, treatment characteristics and procedural details were abstracted for each patient. Primary outcome of the study was D2B in patients with successful pre-hospital EKG transmission compared with patients with no pre-hospital ECG transmission.
Results: 99 consecutive patients were evaluated, of which 88 patients (mean age 56 +/- 10; men 86%) met inclusion criteria. The median D2B for patients arriving via walk in to the ER was 76 minutes. The median D2B for patients transported via FDNY with notification to the ER while in transit was 64.76 minutes. The median D2B for patients arriving in the ER via FDNY with successful ECG transmission was 47.63 minutes. All differences were statistically significant with FDNY vs. walk in time (P=0.0002) and FDNY with notification vs. FDNY with notification and successful ECG transmittal (P=0.01). Overall median D2B was 60 minutes. (Figure 1)
Conclusion: Pre-hospital wireless ECG transmission is associated with a statistically significant reduction in D2B in patients with STEMI undergoing primary PCI. Whether such reduction in D2B translates into better outcomes needs to be determined.
- © 2011 by American Heart Association, Inc.