Abstract 11895: Impact of Prehospital Mobile Cloud ECG System to Reduce Door to Balloon Time and Onset to Recanalization Time in STEMI

Abstract

Background: Clinical guidelines strongly recommend patients with ST-elevation myocardial infarction (STEMI) receive timely mechanical reperfusion, defined as door-to-balloon time (DTBT) ≤90 minutes. Recently, mobile cloud 12-lead ECG transmission system (C-ECG) were becoming popular at low cost. Medical staff can immediately review the ECG via PC or personal hand-held devices, and also track the location of the ambulance in a real time manner. Objective: Evaluate the impact of the prehospital C-ECG on DTBT and mortality in patients with STEMI. Methods: In June 2018, eight mobile C-ECG systems (SCUNA®, MEHERGEN GROUP) were integrated into the Uki city and Kamimashiki city regional EMS departments in Kumamoto Prefecture, We compared the DTBT, onset to recanalization time (OTRT) and mortality rates of STEMI cases for 3 years prior to and 3 years after the C-ECG system. Results: For 6 years study period, 267 STEMI patients were transferred by ambulances from two EMS departments. After excluding 14 patients with onset to arrival time more than 24 hours and 54 patients who were transferred without C-ECG, 199 consecutive STEMI cases underwent emergency PCI in which 100 were prior to C-ECG introduction (Pre-C-ECG, from June 2015 to May 2018) and 99 were after C-ECG (Post-C-ECG, from June 2018 to May 2021). Results: No significant differences were found in age, gender, and Killip classification between the groups. The DTBT and OTRT were significantly shorter in the post-C-ECG compared to the pre-C-ECG (Pre: 68 min [IQR; 43-76] vs. Post: 50 min [IQR; 43-76]; p=0.005, Pre: 190 min [IQR; 138-294] vs. Post: 157 min [IQR; 112-276]; P=0.04, respectively). However, peak-CPK and the in-hospital mortality were not significantly different (Pre: 2068 IU/L [IQR; 1168-4200] vs. Post: 2105 IU/L [IQR; 872-4528]; p=0.8, Pre: 7.0% vs. Post: 5.1%; p=0.6, respectively). Conclusion: Although the prehospital mobile C-ECG system significantly reduced both DTBT and OTRT, the DTBT at our institution was short enough that C-ECG did not reduce the peak CPK or mortality.