title: Effectiveness of a Prehospital Wireless 12-Lead Electrocardiogram and Cardiac Catheterization Laboratory Activation for ST-Elevation Myocardial Infarction.
abstract: The aim of the study was to determine the prevalence of false-positive and inappropriate cardiac catheterization laboratory (CCL) activation in patients suspected with ST-elevation myocardial infarction (STEMI) diverted to a percutaneous coronary intervention (PCI) facility after paramedics wireless 12-lead electrocardiogram transmission to an emergency physician at an online medical control center. This retrospective study collected data from medical records of patients with suspected STEMI from 2006 to 2014. It included demographics, coronaropathic risk factors, cardiac biomarkers, time from the first medical contact to treatment, and final diagnosis. Primary outcome was the rate of false-positive and inappropriate CCL activation. As secondary outcomes, we compared patient characteristics between cases of appropriate and inappropriate CCL activation, and we assessed the presence of cardiac biomarkers, time from first medical contact to start of PCI, and final diagnosis. Overall, 673 patients with suspected STEMI were included in the analysis. A total of 640 patients (95%) had coronarography, of which 10% (62 of 640) did not have a culprit coronary artery (false positive). Angiography was canceled for 5% (33 of 673) of patients. The total false-positive and inappropriate CCL activation rate was 14% (95 of 673). Average time from the first medical contact to the start of PCI was 47 ± 18.1 minutes. Unwanted CCL activations were more likely to involve men aged >65 years and patients with a history of coronary artery disease. In conclusion, our system of transmitted prehospital electrocardiography and STEMI interpretation by emergency physicians at an online medical control center showed a total false-positive and inappropriate CCL activation rate of 14% over the 8-year study period.
authors.affiliation: Unité de Coordination Clinique des Services Préhospitaliers d'Urgences (UCCSPU), Québec, Québec, Canada; Centre de Recherche de l'Hôtel-Dieu de Lévis, Québec, Québec, Canada.
authors.forename: Alain
authors.initials: A
authors.lastname: Tanguay
authors.affiliation: Faculté de Médecine Université Laval, Québec, Québec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Brassard
authors.affiliation: Unité de Coordination Clinique des Services Préhospitaliers d'Urgences (UCCSPU), Québec, Québec, Canada; Centre de Recherche de l'Hôtel-Dieu de Lévis, Québec, Québec, Canada. Electronic address: Johann.Lebon@USherbrooke.ca.
authors.forename: Johann
authors.initials: J
authors.lastname: Lebon
authors.affiliation: Centre de Recherche de l'Hôtel-Dieu de Lévis, Québec, Québec, Canada; Faculté de Médecine Université Laval, Québec, Québec, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Bégin
authors.affiliation: Unité de Coordination Clinique des Services Préhospitaliers d'Urgences (UCCSPU), Québec, Québec, Canada.
authors.forename: Denise
authors.initials: D
authors.lastname: Hébert
authors.affiliation: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Paradis
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods*; D004635:Emergency Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D017216:Telemedicine; D061665:Time-to-Treatment; D055815:Young Adult