title: Pre-hospital electrocardiogram triage with telemedicine near halves time to treatment in STEMI: A meta-analysis and meta-regression analysis of non-randomized studies.
abstract: BACKGROUND
  A shorter time to treatment has been shown to be associated with lower mortality rates in acute myocardial infarction (AMI). Several strategies have been adopted with the aim to reduce any delay in diagnosis of AMI: pre-hospital triage with telemedicine is one of such strategies. We therefore aimed to measure the real effect of pre-hospital triage with telemedicine in case of AMI in a meta-analysis study.
  
  
  METHODS
  We performed a meta-analysis of non-randomized studies with the aim to quantify the exact reduction of time to treatment achieved by pre-hospital triage with telemedicine. Data were pooled and compared by relative time reduction and 95% C.I.s. A meta-regression analysis was performed in order to find possible predictors of shorter time to treatment.
  
  
  RESULTS
  Eleven studies were selected and finally evaluated in the study. The overall relative reduction of time to treatment with pre-hospital triage and telemedicine was -38/-40% (p<0.001). Absolute time reduction was significantly correlated to time to treatment in the control groups (p<0.001), while relative time reduction was independent. A non-significant trend toward shorter relative time reductions was observed over years.
  
  
  CONCLUSIONS
  Pre-hospital triage with telemedicine is associated with a near halved time to treatment in AMI. The benefit is larger in terms of absolute time to treatment reduction in populations with larger delays to treatment.
authors.affiliation: Department of Medical & Surgical Sciences, University of Foggia, Italy.. Electronic address: natale.brunetti@unifg.it.
authors.forename: Natale Daniele
authors.initials: ND
authors.lastname: Brunetti
authors.affiliation: Ospedale San Paolo, Bari, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: De Gennaro
authors.affiliation: Ospedali Riuniti University Hospital, Foggia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Correale
authors.affiliation: Asklepios Klinik Sankt Georg, Hamburg, Germany; Department of Medical & Surgical Sciences, University of Foggia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Santoro
authors.affiliation: Ospedale San Paolo, Bari, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Caldarola
authors.affiliation: Department of Medical & Surgical Sciences, University of Foggia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gaglione
authors.affiliation: Department of Medical & Surgical Sciences, University of Foggia, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Di Biase
mesh_terms: D000068456:Clinical Studies as Topic; D004562:Electrocardiography / Q000379:methods*; D006801:Humans; D012044:Regression Analysis; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis*; D017216:Telemedicine / Q000379:methods*; D061665:Time-to-Treatment; D014218:Triage / Q000379:methods*
keywords: Acute myocardial infarction; Pre-hospital electrocardiogram; Telemedicine; Time-to-balloon; Triage