title: Pre-hospital electrocardiogram triage with tele-cardiology support is associated with shorter time-to-balloon and higher rates of timely reperfusion even in rural areas: data from the Bari- Barletta/Andria/Trani public emergency medical service 118 registry on primary angioplasty in ST-elevation myocardial infarction.
abstract: BACKGROUND
  We report the preliminary data from a regional registry on ST-elevation myocardial infarction (STEMI) patients treated with primary angioplasty in Apulia, Italy; the region is covered by a single public health-care service, a single public emergency medical service (EMS), and a single tele-medicine service provider.
  
  
  METHODS
  Two hundred and ninety-seven consecutive patients with STEMI transferred by regional free public EMS 1-1-8 for primary-PCI were enrolled in the study; 123 underwent pre-hospital electrocardiograms (ECGs) triage by tele-cardiology support and directly referred for primary-PCI, those remaining were just transferred by 1-1-8 ambulances for primary percutaneous coronary intervention (PCI) (diagnosis not based on tele-medicine ECG; already hospitalised patients, emergency-room without tele-medicine support). Time from first ECG diagnostic for STEMI to balloon was recorded; a time-to-balloon <1 h was considered as optimal and patients as timely treated.
  
  
  RESULTS
  Mean time-to-balloon with pre-hospital triage and tele-cardiology ECG was significantly shorter (0:41 ± 0:17 vs 1:34 ± 1:11 h, p<0.001, -0:53 h, -56%) and rates of patients timely treated higher (85% vs 35%, p<0.001, +141%), both in patients from the 'inner' zone closer to PCI catheterisation laboratories (0:34 ± 0:13 vs 0:54 ± 0:30 h, p<0.001; 96% vs 77%, p<0.01, +30%) and in the 'outer' zone (0:52 ± 0:17 vs 1:41 ± 1:14 h, p<0.001; 69% vs 29%, p<0.001, +138%). Results remained significant even after multivariable analysis (odds ratio for time-to-balloon 0.71, 95% confidence interval (CI) 0.63-0.80, p<0.001; 1.39, 95% CI 1.25-1.55, p<0.001, for timely primary-PCI).
  
  
  CONCLUSIONS
  Pre-hospital triage with tele-cardiology ECG in an EMS registry from an area with more than one and a half million inhabitants was associated with shorter time-to-balloon and higher rates of timely treated patients, even in 'rural' areas.
authors.affiliation: Cardiology Department, University of Foggia, Italy natale.brunetti@unifg.it.
authors.forename: Natale Daniele
authors.initials: ND
authors.lastname: Brunetti
authors.affiliation: 1-1-8 Emergency Medical Service Apulia, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Di Pietro
authors.affiliation: Agenzia Regionale Sanità Puglia, Italy.
authors.forename: Ambrogio
authors.initials: A
authors.lastname: Aquilino
authors.affiliation: 1-1-8 Emergency Medical Service Apulia, Italy.
authors.forename: Angela I
authors.initials: AI
authors.lastname: Bruno
authors.affiliation: Cardio On Line Europe S.R.L., Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Dellegrottaglie
authors.affiliation: Cardio On Line Europe S.R.L., Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Giuseppe
authors.affiliation: Cardio On Line Europe S.R.L., Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Lopriore
authors.affiliation: Cardiology Department, University of Foggia, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: De Gennaro
authors.affiliation: U.O. Cardiologia, Ospedale 'Di Venere', Bari, Italy.
authors.forename: Saverio
authors.initials: S
authors.lastname: Lanzone
authors.affiliation: U.O. Cardiologia, Ospedale 'San Paolo', Bari, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Caldarola
authors.affiliation: U.O. Cardiologia, Azienda Ospedaliera Policlinico, Bari, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Antonelli
authors.affiliation: Cardiology Department, University of Foggia, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Di Biase
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D012042:Registries; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012423:Rural Health; D017216:Telemedicine / Q000379:methods*; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014218:Triage / Q000379:methods*
keywords: ST-elevation; Tele-cardiology; acute myocardial infarction; emergency medical service; pre-hospital electrocardiogram; pre-hospital triage; primary coronary angioplasty