The impact of telecardiology on the outcome of patients with myocardial infarction transported by Tehran’s emergency medical services to selected hospitals of Tehran city
,
Abstract
Background & Aim: Clinical outcomes and mortality rate of patients with ST-segment elevation myocardial infarction (STEMI) strongly depend on the time of percutaneous coronary intervention (PCI). One way to reduce the delay in this treatment is to use telecardiology in the prehospital setting. The purpose of this study was for comparison of telecardiology on the first medical contact to balloon time and outcome (size of infarct area, left ventricular ejection fraction, and major adverse cardiac events) of patients with myocardial infarction (MI) transported by Tehran Emergency Medical Services to selected hospitals in Tehran, Iran.
Methods & Materials: The present retrospective, comparative study was conducted in 2018 in Tehran city on the medical records of 300 patients with STEMI transported with and without telecardiology (150 records per group). Data for this study included demographic characteristics; how to transport the patients to medical centers, first medical contact to balloon time (FMCTB), and clinical outcomes. Data were analyzed using independent t-test, Fisher's exact test, Chi-square, Mann-Whitney and Kruskal-Wallis test by SPSS software, Version 20.
Results: First medical contact to balloon (FMCTB) time, infarction size based on creatine kinase, the patient mortality rate in one month, and repeated PCI in the group transported with telecardiology was significantly lower than that of the group transported without telecardiology (P<0.05). Left ventricular ejection fraction (LVEF) in the first 24 hours, infarction size based on troponin I level, the rate of readmission due to acute coronary syndrome (ACS) and the rate of coronary artery bypass grafting (CABG) were not statistically significant between the two groups (P<0.05).
Conclusion: The results of this study showed that the use of telecardiology could reduce the delay in performing PCI and improve some of the clinical outcomes of patients with STEMI. These results can be used to improve the quality of care for patients with STEMI by pre-hospital emergency personnel, physicians and nurses involved in the care of these patients.
1. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation. 2012 Jan;125(1):e2-20.
2. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD. Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation. 2018 Mar 20;137(12):e67.
3. Zand S, Koohestani H, Baghcheghi N, Shah MR. Assessing effectiveness of a cardiac rehabilitation program on outcomes of myocardial infarction. 2011; 6(22): 24-30.
4. Meadows-Pitt M, Fields W. The impact of prehospital 12-lead electrocardiograms on door-to-balloon time in patients with ST-elevation myocardial infarction. Journal of Emergency Nursing. 2014 May 1;40(3):e63-8.
5. Ong ME, Wong AS, Seet CM, Teo SG, Lim BL, Ong PJ, Lai SM, Ong SH, Lee FC, Chan KP, Anantharaman V. Nationwide improvement of door-to-balloon times in patients with acute ST-segment elevation myocardial infarction requiring primary percutaneous coronary intervention with out-of-hospital 12-lead ECG recording and transmission. Annals of emergency medicine. 2013 Mar 1;61(3):339-47.
6. Meshgin Abadi N, Ramezani Badr F, Mahmoodi KH. The use of aromatherapy massage to reduce backpain after percutaneous coronary intervention (PCI): A semi-experimental study. ZUMS Journal. 2013 May 1;21(86):24-34.
7. Kerem Y, Eastvold JS, Faragoi D, Strasburger D, Motzny SE, Kulstad EB. The role of prehospital electrocardiograms in the recognition of ST-segment elevation myocardial infarctions and reperfusion times. The Journal of emergency medicine. 2014 Feb 1;46(2):202-7.
8. Schoos MM, Sejersten M, Hvelplund A, Madsen M, Lønborg J, Steinmetz J, et al. Reperfusion delay in patients treated with primary percutaneous coronary intervention: insight from a real world Danish ST-segment elevation myocardial infarction population in the era of telemedicine. European Heart Journal: Acute Cardiovascular Care. 2012;1(3):200-9.
9. Dorsch MF, Greenwood JP, Priestley C, Somers K, Hague C, Blaxill JM, et al. Direct ambulance admission to the cardiac catheterization laboratory significantly reduces door-to-balloon times in primary percutaneous coronary intervention. American heart journal. 2008;155(6):1054-8.
10. Allaqaband S, Jan MF, Banday WY, Schlemm A, Ahmed SH, Mori N, et al. Impact of 24‐hr in‐hospital interventional cardiology team on timeliness of reperfusion for ST‐segment elevation myocardial infarction. Catheterization and Cardiovascular Interventions. 2010;75(7):1015-23.
11. Menees DS, Peterson ED, Wang Y, Curtis JP, Messenger JC, Rumsfeld JS, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. New England Journal of Medicine. 2013;369(10):901-9.
12. Nielsen PH, Terkelsen CJ, Nielsen TT, Thuesen L, Krusell LR, Thayssen P, et al. System delay and timing of intervention in acute myocardial infarction (from the Danish Acute Myocardial Infarction-2 [DANAMI-2] trial). The American journal of cardiology. 2011;108(6):776-81.
13. McMullan JT, Hinckley W, Bentley J, Davis T, Fermann GJ, Gunderman M, et al. Ground emergency medical services requests for helicopter transfer of ST‐segment elevation myocardial infarction patients decrease medical contact to balloon times in rural and suburban settings. Academic Emergency Medicine. 2012;19(2):153-60.
14. Roswell RO, Greet B, Parikh P, Mignatti A, Freese J, Lobach I, et al. From door‐to‐balloon time to contact‐to‐device time: predictors of achieving target times in patients with ST‐elevation myocardial infarction. Clinical cardiology. 2014;37(7):389-94.
15. Cone DC, Lee CH, Van Gelder C. EMS activation of the cardiac catheterization laboratory is associated with process improvements in the care of myocardial infarction patients. Prehospital Emergency Care. 2013;17(3):293-8.
16. Bata I, Armstrong PW, Westerhout CM, Travers A, Sookram S, Caine E, et al. Time from first medical contact to reperfusion in ST elevation myocardial infarction: a Which Early ST Elevation Myocardial Infarction Therapy (WEST) substudy. Canadian Journal of Cardiology. 2009;25(8):463-8.
17. Bassand J-P, Danchin N, Filippatos G, Gitt A, Hamm C, Silber S, et al. Implementation of reperfusion therapy in acute myocardial infarction. A policy statement from the European Society of Cardiology. European heart journal. 2005;26(24):2733-41.
18. Nam J, Caners K, Bowen JM, Welsford M, O'Reilly D. Systematic review and meta-analysis of the benefits of out-of-hospital 12-lead ECG and advance notification in ST-segment elevation myocardial infarction patients. Annals of emergency medicine. 2014;64(2):176-86.
19. Saberian P, Tavakoli N, Ramim T, Hasani-Sharamin P, Shams E, Baratloo A. The Role of Pre-Hospital Telecardiology in Reducing the Coronary Reperfusion Time; a Brief Report. Archives of academic emergency medicine. 2019;7(1):5.
20. Sørensen JT, Terkelsen CJ, Nørgaard BL, Trautner S, Hansen TM, Bøtker HE, et al. Urban and rural implementation of pre-hospital diagnosis and direct referral for primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction. European heart journal. 2010;32(4):430-6.
21. Kobayashi A, Misumida N, Aoi S, Steinberg E, Kearney K, Fox JT, et al. STEMI notification by EMS predicts shorter door-to-balloon time and smaller infarct size. The American journal of emergency medicine. 2016;34(8):1610-1613.
22. Mrdovic I, Savic L, Krljanac G, Asanin M, Perunicic J, Lasica R, et al. Predicting 30-day major adverse cardiovascular events after primary percutaneous coronary intervention. The RISK-PCI score. International journal of cardiology. 2013;162(3): 220-7.
23. Saberian P, Sharamin PH, Dadashi F. Emergency Medical Service Concepts in Tehran, Iran. Journal of Orthopedic and Spine Trauma. 2017;3(3).
24. Politi L, Sgura F, Rossi R, Monopoli D, Guerri E, Leuzzi C, et al. A randomised trial of target-vessel versus multi-vessel revascularisation in ST-elevation myocardial infarction: major adverse cardiac events during long-term follow-up. Heart. 2010;96(9):662-7.
25. Cheskes S, Turner L, Foggett R, Huiskamp M, Popov D, Thomson S, et al. Paramedic contact to balloon in less than 90 minutes: a successful strategy for ST-segment elevation myocardial infarction bypass to primary percutaneous coronary intervention in a Canadian emergency medical system. Prehospital Emergency Care. 2011;15(4):490-8.
26. Brunetti ND, Di Pietro G, Aquilino A, Bruno AI, Dellegrottaglie G, Di Giuseppe G, et al. 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. European Heart Journal: Acute Cardiovascular Care. 2014;3(3):204-13.
27. Hutchison AW, Malaiapan Y, Cameron JD, Meredith IT. Pre-hospital 12 lead ECG to triage ST elevation myocardial infarction and long term improvements in door to balloon times: The first 1000 patients from the MonAMI project. Heart, Lung and Circulation. 2013;22(11):910-6.
28. Kawakami S, Tahara Y, Noguchi T, Yagi N, Kataoka Y, Asaumi Y, et al. Time to reperfusion in ST-segment elevation myocardial infarction patients with vs. without pre-hospital mobile telemedicine 12-lead electrocardiogram transmission. Circulation Journal. 2016:80(7): 1624-1633.
29. Ezad S, Davies AJ, Cheema H, Williams T, Leitch J. Keys to Achieving Target First Medical Contact to Balloon Times and Bypassing Emergency Department More Important Than Distance. Cardiology research and practice. 2018;2018.
30. Savage ML, Poon KK, Johnston EM, Raffel OC, Incani A, Bryant J, et al. Pre-hospital ambulance notification and initiation of treatment of ST elevation myocardial infarction is associated with significant reduction in door-to-balloon time for primary PCI. Heart, Lung and Circulation. 2014;23(5):435-43.
31. Clemmensen P, Sejersten M, Sillesen M, Hampton D, Wagner GS, Loumann-Nielsen S. Diversion of ST-elevation myocardial infarction patients for primary angioplasty based on wireless prehospital 12-lead electrocardiographic transmission directly to the cardiologist's handheld computer: a progress report. Journal of Electrocardiology. 2005;38(4):194-8.
2. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD. Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation. 2018 Mar 20;137(12):e67.
3. Zand S, Koohestani H, Baghcheghi N, Shah MR. Assessing effectiveness of a cardiac rehabilitation program on outcomes of myocardial infarction. 2011; 6(22): 24-30.
4. Meadows-Pitt M, Fields W. The impact of prehospital 12-lead electrocardiograms on door-to-balloon time in patients with ST-elevation myocardial infarction. Journal of Emergency Nursing. 2014 May 1;40(3):e63-8.
5. Ong ME, Wong AS, Seet CM, Teo SG, Lim BL, Ong PJ, Lai SM, Ong SH, Lee FC, Chan KP, Anantharaman V. Nationwide improvement of door-to-balloon times in patients with acute ST-segment elevation myocardial infarction requiring primary percutaneous coronary intervention with out-of-hospital 12-lead ECG recording and transmission. Annals of emergency medicine. 2013 Mar 1;61(3):339-47.
6. Meshgin Abadi N, Ramezani Badr F, Mahmoodi KH. The use of aromatherapy massage to reduce backpain after percutaneous coronary intervention (PCI): A semi-experimental study. ZUMS Journal. 2013 May 1;21(86):24-34.
7. Kerem Y, Eastvold JS, Faragoi D, Strasburger D, Motzny SE, Kulstad EB. The role of prehospital electrocardiograms in the recognition of ST-segment elevation myocardial infarctions and reperfusion times. The Journal of emergency medicine. 2014 Feb 1;46(2):202-7.
8. Schoos MM, Sejersten M, Hvelplund A, Madsen M, Lønborg J, Steinmetz J, et al. Reperfusion delay in patients treated with primary percutaneous coronary intervention: insight from a real world Danish ST-segment elevation myocardial infarction population in the era of telemedicine. European Heart Journal: Acute Cardiovascular Care. 2012;1(3):200-9.
9. Dorsch MF, Greenwood JP, Priestley C, Somers K, Hague C, Blaxill JM, et al. Direct ambulance admission to the cardiac catheterization laboratory significantly reduces door-to-balloon times in primary percutaneous coronary intervention. American heart journal. 2008;155(6):1054-8.
10. Allaqaband S, Jan MF, Banday WY, Schlemm A, Ahmed SH, Mori N, et al. Impact of 24‐hr in‐hospital interventional cardiology team on timeliness of reperfusion for ST‐segment elevation myocardial infarction. Catheterization and Cardiovascular Interventions. 2010;75(7):1015-23.
11. Menees DS, Peterson ED, Wang Y, Curtis JP, Messenger JC, Rumsfeld JS, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. New England Journal of Medicine. 2013;369(10):901-9.
12. Nielsen PH, Terkelsen CJ, Nielsen TT, Thuesen L, Krusell LR, Thayssen P, et al. System delay and timing of intervention in acute myocardial infarction (from the Danish Acute Myocardial Infarction-2 [DANAMI-2] trial). The American journal of cardiology. 2011;108(6):776-81.
13. McMullan JT, Hinckley W, Bentley J, Davis T, Fermann GJ, Gunderman M, et al. Ground emergency medical services requests for helicopter transfer of ST‐segment elevation myocardial infarction patients decrease medical contact to balloon times in rural and suburban settings. Academic Emergency Medicine. 2012;19(2):153-60.
14. Roswell RO, Greet B, Parikh P, Mignatti A, Freese J, Lobach I, et al. From door‐to‐balloon time to contact‐to‐device time: predictors of achieving target times in patients with ST‐elevation myocardial infarction. Clinical cardiology. 2014;37(7):389-94.
15. Cone DC, Lee CH, Van Gelder C. EMS activation of the cardiac catheterization laboratory is associated with process improvements in the care of myocardial infarction patients. Prehospital Emergency Care. 2013;17(3):293-8.
16. Bata I, Armstrong PW, Westerhout CM, Travers A, Sookram S, Caine E, et al. Time from first medical contact to reperfusion in ST elevation myocardial infarction: a Which Early ST Elevation Myocardial Infarction Therapy (WEST) substudy. Canadian Journal of Cardiology. 2009;25(8):463-8.
17. Bassand J-P, Danchin N, Filippatos G, Gitt A, Hamm C, Silber S, et al. Implementation of reperfusion therapy in acute myocardial infarction. A policy statement from the European Society of Cardiology. European heart journal. 2005;26(24):2733-41.
18. Nam J, Caners K, Bowen JM, Welsford M, O'Reilly D. Systematic review and meta-analysis of the benefits of out-of-hospital 12-lead ECG and advance notification in ST-segment elevation myocardial infarction patients. Annals of emergency medicine. 2014;64(2):176-86.
19. Saberian P, Tavakoli N, Ramim T, Hasani-Sharamin P, Shams E, Baratloo A. The Role of Pre-Hospital Telecardiology in Reducing the Coronary Reperfusion Time; a Brief Report. Archives of academic emergency medicine. 2019;7(1):5.
20. Sørensen JT, Terkelsen CJ, Nørgaard BL, Trautner S, Hansen TM, Bøtker HE, et al. Urban and rural implementation of pre-hospital diagnosis and direct referral for primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction. European heart journal. 2010;32(4):430-6.
21. Kobayashi A, Misumida N, Aoi S, Steinberg E, Kearney K, Fox JT, et al. STEMI notification by EMS predicts shorter door-to-balloon time and smaller infarct size. The American journal of emergency medicine. 2016;34(8):1610-1613.
22. Mrdovic I, Savic L, Krljanac G, Asanin M, Perunicic J, Lasica R, et al. Predicting 30-day major adverse cardiovascular events after primary percutaneous coronary intervention. The RISK-PCI score. International journal of cardiology. 2013;162(3): 220-7.
23. Saberian P, Sharamin PH, Dadashi F. Emergency Medical Service Concepts in Tehran, Iran. Journal of Orthopedic and Spine Trauma. 2017;3(3).
24. Politi L, Sgura F, Rossi R, Monopoli D, Guerri E, Leuzzi C, et al. A randomised trial of target-vessel versus multi-vessel revascularisation in ST-elevation myocardial infarction: major adverse cardiac events during long-term follow-up. Heart. 2010;96(9):662-7.
25. Cheskes S, Turner L, Foggett R, Huiskamp M, Popov D, Thomson S, et al. Paramedic contact to balloon in less than 90 minutes: a successful strategy for ST-segment elevation myocardial infarction bypass to primary percutaneous coronary intervention in a Canadian emergency medical system. Prehospital Emergency Care. 2011;15(4):490-8.
26. Brunetti ND, Di Pietro G, Aquilino A, Bruno AI, Dellegrottaglie G, Di Giuseppe G, et al. 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. European Heart Journal: Acute Cardiovascular Care. 2014;3(3):204-13.
27. Hutchison AW, Malaiapan Y, Cameron JD, Meredith IT. Pre-hospital 12 lead ECG to triage ST elevation myocardial infarction and long term improvements in door to balloon times: The first 1000 patients from the MonAMI project. Heart, Lung and Circulation. 2013;22(11):910-6.
28. Kawakami S, Tahara Y, Noguchi T, Yagi N, Kataoka Y, Asaumi Y, et al. Time to reperfusion in ST-segment elevation myocardial infarction patients with vs. without pre-hospital mobile telemedicine 12-lead electrocardiogram transmission. Circulation Journal. 2016:80(7): 1624-1633.
29. Ezad S, Davies AJ, Cheema H, Williams T, Leitch J. Keys to Achieving Target First Medical Contact to Balloon Times and Bypassing Emergency Department More Important Than Distance. Cardiology research and practice. 2018;2018.
30. Savage ML, Poon KK, Johnston EM, Raffel OC, Incani A, Bryant J, et al. Pre-hospital ambulance notification and initiation of treatment of ST elevation myocardial infarction is associated with significant reduction in door-to-balloon time for primary PCI. Heart, Lung and Circulation. 2014;23(5):435-43.
31. Clemmensen P, Sejersten M, Sillesen M, Hampton D, Wagner GS, Loumann-Nielsen S. Diversion of ST-elevation myocardial infarction patients for primary angioplasty based on wireless prehospital 12-lead electrocardiographic transmission directly to the cardiologist's handheld computer: a progress report. Journal of Electrocardiology. 2005;38(4):194-8.
| Files | ||
| Issue | Vol 7 No 1 (2020): Winter | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/npt.v7i1.2303 | |
| Keywords | ||
| angioplasty; myocardial infarction; telemedicine | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mohammadi Janbazloufar K, Pazokian M, Safari M, Saberian P, Nasiri M. The impact of telecardiology on the outcome of patients with myocardial infarction transported by Tehran’s emergency medical services to selected hospitals of Tehran city. NPT. 2020;7(1):72-80.
