The STAT-MI (ST-Segment Analysis Using Wireless Technology in Acute Myocardial Infarction) Trial Improves Outcomes

Sanchez-Ross, Monica; Oghlakian, Gerard; Mäher, James; Patel, Brijesh; Mazza, Victor; Hom, David L.; Dhruva, Vivek N; Langley, D.B.; Palmaro, Jack; Ahmed, Sultan; Kaluski, Edo; Klapholz, Marc

doi:10.1016/j.jcin.2010.11.007

Cited by 80 publications

(58 citation statements)

References 22 publications

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“…[26][27][28] However, in the United States, this group typically constitutes a small fraction of the total STEMI population in each network. 15,29 For the majority of STEMI patients, our data suggest that continued emphasis on the triage and diagnostic period in the ED is paramount to establishing consistently lower time to reperfusion therapy.…”

Section: Discussionmentioning

confidence: 83%

Impact of Door-to-Activation Time on Door-to-Balloon Time in Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarctions

McCabe

Armstrong

Hoffmayer

et al. 2012

Circ: Cardiovascular Quality and Outcomes

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Background-Little is known about the components of door-to-balloon time among patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. We assessed the role of time from hospital arrival to ST-segment elevation myocardial infarction diagnosis (door-to-activation time) on door-to-balloon time in contemporary practice and evaluated factors that influence door-to-activation times. Methods and Results-Registry data on 347 consecutive patients diagnosed with a ST-segment elevation myocardial infarction in the emergency department over 30 months at 2 urban primary percutaneous coronary intervention centers were analyzed. The primary study end point was the time from hospital arrival to catheterization laboratory activation by the emergency department physician, and we assessed factors associated with this period. Door-to-balloon time and its other components were secondary study end points. The median door-to-activation time was 19 minutes (interquartile range, 9-54). Variation in door-to-activation times explained 93% of the variation in door-to-balloon times and demonstrated the strongest correlation with door-to-balloon times (r=0.97). Achieving a door-to-activation time of ≤20 minutes resulted in an 89% chance of achieving a door-to-balloon time of ≤90 minutes compared with only 28% for patients with a door-to-activation time >20 minutes. Factors significantly associated with door-to-activation time include the following: prehospital ECG use (61% shorter, 95% confidence interval, −50 to −72%; P<0.001) and computed tomography scan use in the emergency department (245% longer, 95% confidence interval, +50 to +399%; P=0.001). Conclusions-The interval from hospital arrival to ST-segment elevation myocardial infarction diagnosis and catheterization laboratory activation (door-to-activation time) is a strong driver of overall door-to-balloon times. Achieving a door-toactivation time ≤20 minutes was key to achieving a door-to-balloon time ≤90 minutes. Delays in door-to-activation time are not associated with delays in other aspects of the primary percutaneous coronary intervention process. (Circ Cardiovasc Qual Outcomes. 2012;5:672-679.)Key Words: outcome and process ◼ emergency department ◼ door-to-balloon time ◼ door-to-activation time ◼ primary percutaneous coronary intervention ◼ ST-segment elevation myocardial infarction

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Section: Discussionmentioning

confidence: 83%

Impact of Door-to-Activation Time on Door-to-Balloon Time in Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarctions

McCabe

Armstrong

Hoffmayer

et al. 2012

Circ: Cardiovascular Quality and Outcomes

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“…The early evaluation and triage of patients with ST-elevation acute myocardial infarction with telemedicine technologies shortens door to balloon times, reduces infarct size, limits ejection fraction reduction, and shortens length of stay [24]. A dramatic 60% reduction in early and late mortality was observed in large registries on acute myocardial infarction with the use of pre-hospital electrocardiogram supported by telemedicine [25]; pre-hospital triage was an independent predictor for survival at 1 year (hazard ratio: 0.37, 95% confidence interval: 0.18-0.75).…”

Section: Telemedicine For Acute Coronary Syndromementioning

confidence: 99%

Telemedicine for cardiovascular disease continuum: A position paper from the Italian Society of Cardiology Working Group on Telecardiology and Informatics

Brunetti

Scalvini

Acquistapace³

et al. 2015

International Journal of Cardiology

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Telemedicine is the provision of health care services, through the use of information and communication technology, in situations where the health care professional and the patient, or 2 health care professionals, are not in the same location. It involves the secure transmission of medical data and information, through text, sound, images, or other forms needed for the prevention, diagnosis, treatment, and follow-up of a patient. First data on implementation of telemedicine for the diagnosis and treatment of acute myocardial infarction date from more than 10 years ago. Telemedicine has a potential broad application to the cardiovascular disease continuum and in many branches of cardiology, at least including heart failure, ischemic heart disease and arrhythmias. Telemedicine might have an important role as part of a strategy for the delivery of effective health care for patients with cardiovascular disease. In this document the Working Group on Telecardiology and Informatics of the Italian Society of Cardiology intends to remark some key-points regarding potential benefit achievable with the implementation of telemedicine support in the continuum of cardiovascular disease.

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“…11) In Japan, a system in which a pre-hospital 12-lead ECG can be sent by fax has been in use until now, but because the information transmission is limited and the usability of the information at the destination hospitals is also limited, this system has never been widely used. In the STAT-MI study, 12,13) it was reported that the time to contact a cardiovascular specialist after the arrival of the EMS team and the time between patient arrival at the hospital and reperfusion were shortened as a result of sending pre-hospital 12-lead ECG data in the form of a PDF file in advance. Moreover, a study in Denmark reported that the door-to-balloon time was shortened by telephotographing a prehospital 12-lead ECG in advance of hospital arrival.…”

Section: Discussionmentioning

confidence: 99%

Use of a Mobile Telemedicine System during the Transport of Emergency Myocardial Infarction Patients Would Be an Effective Technology in the Pre-hospital Medical Setting

et al. 2014

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It is not rare for patients with acute myocardial infarction(AMI) to die suddenly outside the hospital or for their condition to become more serious as a result of delays in treatment, and setting up an effective pre-hospital medical system before admission to a hospital is an urgent task for reducing the AMI-related mortality rate. Because half of all patients who die as a result of AMI do so before reaching a hospital, the 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science (G2010) advised that the interval between emergency medical service (EMS) contact with a patient and balloon inflation to achieve reperfusion (EMS-toballoon time) should be no more than 90 minutes. Also, the American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Practice Guidelines 1) recommends minimizing the total ischemic time and a first medical contactto-balloon time of within 90 minutes for patients with AMI. Although pre-hospital 12-lead electrocardiogram (ECG) recordings can provide advance information to the hospital, it is important to shorten both the time between the arrival of the patient at the hospital and the recording of the first ECG as well as the time between the ECG recording and the start of reperfusion therapy, 2-5) a practice that has not been widely adopted in Japan. We have developed a mobile telemedicine system (MTS) 6) that utilizes mobile communications via cellular phones, making it possible to transmit biological information, including 12-lead ECG data, blood pressures, respiration rates, pulse rates and in-vehicle images acquired with a small camera, continuously from an ambulance while the patient is being transported to the destination hospital in real time.We have started to apply our newly developed MTS, which continuously transmits biological information from ambulancesin real time, and tested the validity of this technology in a pre- Background:We have developed a mobile telemedicine system (MTS) utilizing mobile communications via cellular phones, making it possible to continuously transmit biological information, including 12-lead electrocardiography data, from an ambulance while the patient is being transported to the destination hospital in real time. Purpose: We evaluated whether using an MTS during the transport of acute myocardial infarction patients shortens the interval between arrival at the hospital and balloon inflation to achieve reperfusion (doorto-balloon time). Two hundred eighteen consecutive AMI patients were divided into two groups: 23 patients who had been brought to the hospital in an ambulance equipped with an MTS, and 195 patients who had been brought to the hospital without the use of an MTS. Results: When the MTS group and the non-MTS group were compared, no differences in clinical characteristics , Killip class, incidence of emergency coronary angiography, culprit lesion, or prevalence of multi-vessel disease were seen. No significant differences were seen between the two groups in terms of the in...

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The STAT-MI (ST-Segment Analysis Using Wireless Technology in Acute Myocardial Infarction) Trial Improves Outcomes

Abstract: A fully automated, field-based, wireless network that transmits ECGs automatically to offsite cardiologists for the early evaluation and triage of patients with STEMI shortens D2B times, reduces infarct size, limits ejection fraction reduction, and shortens LOS.

Cited by 80 publications

References 22 publications

Impact of Door-to-Activation Time on Door-to-Balloon Time in Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarctions

Impact of Door-to-Activation Time on Door-to-Balloon Time in Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarctions

Telemedicine for cardiovascular disease continuum: A position paper from the Italian Society of Cardiology Working Group on Telecardiology and Informatics

Use of a Mobile Telemedicine System during the Transport of Emergency Myocardial Infarction Patients Would Be an Effective Technology in the Pre-hospital Medical Setting

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