The transtelephonic electrocardiogram-based triage is an independent predictor of decreased hospital mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. (May 2020)

• Record Type: Journal Article
• Authors: Papai, Gyorgy; Csato, Gabor; Racz, Ildiko; Szabo, Gabor; Barany, Tamas; Racz, Agnes; Szokol, Miklos; Sarman, Balazs; Edes, Istvan F; Czuriga, Daniel; Kolozsvari, Rudolf; Edes, Istvan
• Is Part Of: Journal of telemedicine and telecare. Volume 26:Number 4(2020)
• Page Start: 216
• Page End: 222
• Publication Date: 2020-05
• Subjects: Remote consultation -- telecardiology -- teleconsulting -- telemedicine; Telecommunication in medicine -- Periodicals; 610
• DOI: 10.1177/1357633X18814335
• Languages: English
• ISSNs: 1357-633X

Abstract

Introduction: The transtelephonic electrocardiogram has been shown to have a great value in the management of out-of-hospital chest pain emergencies. In our previous study it not only improved the pre-hospital medical therapy and time to intervention, but also the in-hospital mortality in ST-segment elevation myocardial infarction. It was hypothesised that the higher in-hospital survival rate could be due to improved transtelephonic electrocardiogram-based pre-hospital management (electrocardiogram interpretation and teleconsultation) and consequently, better coronary perfusion of patients at the time of hospital admission. To test this hypothesis, our database of ST-segment elevation myocardial infarction patients was evaluated retrospectively for predictors (including transtelephonic electrocardiogram) that may influence in-hospital survival. Methods and results: The ST-segment elevation myocardial infarction patients were divided into two groups, namely (a) hospital death patients ( n = 49) and (b) hospital survivors (control, n = 726). Regarding pre-hospital medical management, the transtelephonic electrocardiogram-based triage (odds ratio 0.48, confidence interval 0.25–0.92, p = 0.0261) and the administration of optimal pre-hospital medical therapy (acetylsalicylic acid and/or clopidogrel and glycoprotein IIb/IIIa inhibitor) were the most important independent predictors for a decreased risk in our model. At the same time, age, acute heart failure (Killip class >2), successful pre-hospital resuscitation and total occlusion of the infarct-related coronary artery before percutaneous coronary intervention were the most important independent predictors for an increased risk of in-hospital mortality. Discussion: In ST-segment elevation myocardial infarction patients, (a) an early transtelephonic electrocardiogram-based teleconsultation and triage, (b) optimal pre-hospital antithrombotic medical therapy and (c) the patency and better perfusion of the infarct-related coronary artery on hospital admission are important predictors of a lower in-hospital mortality rate.