Abstract 16688: Trans-Satellite Wireless 12 Lead ECG Transmission From the Ambulance to the Primary PCI Facility as Part of Nationwide Primary PCI Program for ST-Elevation Myocardial Infarction

Abstract

Introduction: Time is recognized as a crucial factor in the success of Primary PCI (PPCI). We have installed a “Nationwide” Trans-Satellite Wireless ECG Transfer (W-ECG) which enables swift identification of STEMI and direct transfer to the PPCI facility in Heart Hospital (HH). It also initiates PPCI staff to be ready even before patient arrives, and eliminates delays in Emergency rooms. Methods: Of 510 patients who had PPCI for STEMI, 282 (55%) were transferred directly to the Heart Hospital (HH). These were compared with 228 patients (45%) who went to other hospitals first (OH) before transfer to the HH. Age was similar 50.2 vs 50 years and there was no Ethnic difference (73% Asians and 26% Arabs) in both groups. We compared the two with regard to achieving the optimal Door to Balloon Time (DBT) of 90min for PPCI facility (HH), versus 120min for the OH group, as per guidelines. Results: The DBT was 53±23min for HH group vs 104±55min in OH group (p<0.001). However, while 88% achieved <90min in HH group, only 70% achieved <120min in OH group, p<0.001. Furthermore, Out of Hospital Delay ( OHD i.e delay from symptoms until arrival to hospital) was also different. Patients who had W-ECG arrived faster to HH and thus had shorter OHD (198±183min) than those using own transport to HH (287±276min). Although OHD was longer in HH group (216±212) than OH group (201±172min), the combined OHD+DBT= (Total delay from symptoms to Balloon) was still shorter in HH (W-ECG) group (269min) than similar group going to OH (305min), thus saving 36 vital minutes. Although initial TIMI-0 flow was similar (HH 46% vs OH 44%), TIMI-III flow was achieved more often in HH (97%) than in OH group (92%). Peak Troponin (ng/ml) was also higher in OH group (71251) vs (6576) in HH, p<0.05. While Ejection fraction was similar (HH 45% vs OH 43%), in-hospital mortality was higher in OH group (3.5%) vs (2.5%) in HH, p=0.05. Length of stay was also longer in OH (4.3±4.7) compared to 3.4±3.1 in HH group, p=0.005. Conclusion: Trans-satellite wireless ECG from the ambulance to Primary PCI facility results in significantly shorter DBT, total symptoms to balloon time, and length of stay, as well lower peak Troponin and a trend towards lower in-hospital mortality. Continued study and wider use will further confirm the impact of this technology.