Journal of electrocardiology
-
Review
Novel technical solutions for wireless ECG transmission & analysis in the age of the internet cloud.
Current guidelines recommend early reperfusion therapy for ST-elevation myocardial infarction (STEMI) within 90 min of first medical encounter. Telecardiology entails the use of advanced communication technologies to transmit the prehospital 12-lead electrocardiogram (ECG) to offsite cardiologists for early triage to the cath lab; which has been shown to dramatically reduce door-to-balloon time and total mortality. ⋯ Current and potential solutions to address each of these technical challenges are discussed in details and include: automated ECG transmission protocols; annotatable waveform-based ECGs; optimal routing solutions; and the use of cloud computing systems rather than vendor-specific processing stations. Nevertheless, strategies to monitor transmission effectiveness and patient outcomes are essential to sustain initial gains of implementing ECG transmission technologies.
-
Comparative Study
New ST-segment elevation myocardial infarction criteria for left bundle branch block based on QRS area.
ECG detection of ST-segment elevation myocardial infarction (STEMI) in the presence of left bundle-branch block (LBBB) is challenging due to ST deviation from the altered conduction. The purpose of this study was to introduce a new algorithm for STEMI detection in LBBB and compare the performance to three existing algorithms. ⋯ As can be seen from the difference between Sgarbossa score ≥ 3 and other algorithms for STEMI in LBBB, a discordant ST elevation criterion improves the sensitivity for detection but also results in a drop in specificity. For applications of automated STEMI detection that require higher sensitivity, the Selvester algorithm is better. For applications that require a low false positive rate such as relying on the algorithm for pre-hospital activation of cardiac catheterization laboratory for urgent PCI, it may be better to use the 2 lead Philips QRS area or Smith 25% S-wave algorithm.
-
Patients with ST elevation (STE) in ≥ 2 leads or ST depression (STD) confined to V₁-V₄ are defined as potential STE myocardial infarction (STEMI). We evaluated the incidence of missed STEMI over an 11-month period. ⋯ A significant percentage of patients met STEMI ECG criteria. A large number of patients with STD in V₁-V₆ had angiographic evidence compatible with inferolateral (posterior) STEMI equivalent.
-
Early reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) is essential. Although primary percutaneous coronary intervention (pPCI) is the preferred revascularization technique, it often involves longer primary transportation or secondary inter-hospital transfers and thus longer system related delays. The current ESC Guidelines state that PCI should be performed within 120 minutes from first medical contact, and door-to-balloon time should be <60 minutes in order to reduce long term mortality. ⋯ Based on data from more than 100 patients transferred over the past decade, we have found a similar in-hospital and long term mortality rate compared to the main island inhabitants. In conclusion, with the optimal collaboration within a STEMI network including local hospitals, university clinics, EMS and military helicopters using the same telemedicine system and field triage of STEMI patients, most patients can be treated within the time limits suggested by the current guidelines. These organizational changes are likely to contribute to the improved mortality rate for STEMI patients.
-
To improve patient outcome, point-of-care (POC) cardiac troponin I/T (cTn I/T) tests applied in a prehospital setting and/or emergency department might play a role as a substitute for central hospital laboratory high-sensitivity (hs) cTn I/T testing if their analytical and clinical performance are equivalent to central hospital laboratory hs cTn I/T tests and if they fulfill an unmet clinical need in the diagnostic work-up of patients with acute coronary syndrome (ACS). To date, current point-of-care (POC) cTn I/T tests are not yet sufficiently analytically sensitive and do not provide accurate and precise values in the reference range nor at the 99th percentile of a healthy reference population. ⋯ Although patients with acute ST-segment elevation myocardial infarction (STEMI) are generally diagnosed by ischemic symptoms and ECG only, hospitalized patients with non-STEMI and unstable angina pectoris (UAP) should preferentially be tested with ECG and central hospital laboratory hs cTn I/T tests unless the ECG has already demonstrated diagnostic changes. More evidence and future trials are needed to find out whether in patients with NSTE ACS hs cTn I/T tests should be combined with other tests, such as a test of B-type natriuretic peptide or NT-proBNP.