Abstract 18309: Wireless Electrocardiographic Transmission with e-Activation of PCI Team and Reconstructed System of Care Shortens Door-to-Balloon Time in Acute Myocardial Infarction
Background: Early reperfusion of the occluded coronary artery is the first priority in the treatment of acute ST-elevation myocardial infarction (STEMI). Time to primary percutaneous coronary intervention (PCI) can be shortened by improved system of care. Electronic transmission of electrocardiogram (ECG) to cardiologist's cell phone enables earlier activation of the PCI team. We therefore sought to improve the door-to-balloon (DTB) time by e-technologies and reorganized system of care.
Methods: An ECG system capable of wireless cell phone transmission and e-activation of PCI team (Fig 1A) was introduced to a university medical center in Dec., 2009. The processing of STEMI patients was also reorganized, including performance of ECG at the triage of emergency room (ER) with immediate physician's confirmation, e-transmission of ECG to cardiologist's cell phone with e-activation of the PCI team, standardized ER treatment with prompt transportation to catheterization lab, packaged PCI instruments, and integrated care at the catheterization room. The door-to-ECG (DTE), door-to-door (DTD) and DTB times of STEMI were recorded. The achievement rate of DTE < 10 min, DTD < 60 min and DTB < 90 min were also analyzed. Comparison was made between 2009 and 2010.
Results: Sixty one STEMI patients eligible for PCI in 2009 and 62 in 2010 were included. After implementation of the above system, the rate of DTE < 10 min was increased from 55.7% in 2009 to 90.3% in 2010 (P < 0.001). The rate of DTD < 60 min was raised from 50.8% to 85.5% (P < 0.001), and rate of DTB < 90 min raised from 65.6% to 88.7% (P < 0.01). The average DTE, DTD and DTB times were also significantly shortened (all P < 0.001, Fig 1B).
Conclusion: Electronic ECG transmission to cell phone enables early notification of STEMI and rapid activation of PCI team. Combined with reconstructed in-hospital system of care, these altogether lead to shortened DTE, DTD and DTB times, better compliance with the guidelines and improved quality of care.
- Acute coronary syndromes
- Myocardial infarction, STEMI
- Quality of medical care
- Quality improvement
- © 2011 by American Heart Association, Inc.