Pre-hospital synthesized 12-lead ECG ischemia monitoring with trans-telephonic transmission in acute coronary syndromes: pilot study results of the ST SMART trial.
BACKGROUND
The aim of the ST SMART trial is to determine whether prehospital ST monitoring with telephone transmission to the target hospital will improve hospital time to treatment in acute coronary syndromes. The present analysis reports results of the feasibility pilot study.


METHODS
All patients calling 911 for chest pain in Santa Cruz County California were monitored with a synthesized 12-lead ECG. Prehospital ECGs were printed for clinical use in the experimental group; control group patient care used only ECGs recorded after hospital arrival.


RESULTS
Five patients with non-ST elevation myocardial infarction or unstable angina had normal ECGs upon hospital arrival but evidence of ischemia in their prehospital ECGs. Three patients with ST elevation myocardial infarction were treated with primary percutaneous coronary intervention, with "door to balloon" times of 47 and 65 minutes in 2 experimental group patients and 148 minutes in the one control group patient.


CONCLUSIONS
Prehospital ST monitoring appears feasible. Its potential to improve hospital time to diagnosis and treatment in acute coronary syndromes, and the clinical benefits of such improvement will be studied in the larger, ongoing ST SMART trial.
Drew
Barbara J
BJ
Department of Physiological Nursing, University of California, San Francisco, CA 94143-0610, USA. barbara.drew@nursing.ucsf.edu
Dempsey
Elise D
ED
Joo
Tae H
TH
Sommargren
Claire E
CE
Glancy
James P
JP
Benedict
Kent
K
Krucoff
Mitchell W
MW
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000628:therapy; D000789:Angina, Unstable / Q000175:diagnosis / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000175:diagnosis* / Q000628:therapy; D004554:Electric Countershock / Q000295:instrumentation; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation / Q000379:methods*; D004632:Emergency Medical Services; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000628:therapy; D010865:Pilot Projects; D011446:Prospective Studies; D012815:Signal Processing, Computer-Assisted; D013689:Telephone; D013997:Time Factors