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CLINICAL RESEARCH: ACUTE MYOCARDIAL INFARCTION

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

Vivek N. Dhruva, DO^_*, Samir I. Abdelhadi, DO^_*, Ather Anis, MD^_*, William Gluckman, DO, FAEP, David Hom, MS, William Dougan, MICP, Edo Kaluski, MD, FACC^_*, Bunyad Haider, MD, FACC^_* and Marc Klapholz, MD, FACC^_*,_*

^_* Division of Cardiology, Department of Medicine
Division of Emergency Medicine, Department of Surgery
Department of Medicine, University of Medicine and Dentistry, New Jersey—New Jersey Medical School, Newark, New Jersey

Manuscript received February 21, 2007; revised manuscript received April 26, 2007, accepted April 30, 2007.

^_* Reprint requests and correspondence: Dr. Marc Klapholz, UMDNJ—New Jersey Medical School, 185 South Orange Avenue, MSB I-538, Newark, New Jersey 07103 (Email: klapholz{at}umdnj.edu).

Objectives: Our goal was to examine the effects of implementing a fully automated wireless network to reduce door-to-intervention times (D2I) in ST-segment elevation myocardial infarction (STEMI).

Background: Wireless technologies used to transmit prehospital electrocardiograms (ECGs) have helped to decrease D2I times but have unrealized potential.

Methods: A fully automated wireless network that facilitates simultaneous 12-lead ECG transmission from emergency medical services (EMS) personnel in the field to the emergency department (ED) and offsite cardiologists via smartphones was developed. The system is composed of preconfigured Bluetooth devices, preprogrammed receiving/transmitting stations, dedicated e-mail servers, and smartphones. The network facilitates direct communication between offsite cardiologists and EMS personnel, allowing for patient triage directly to the cardiac catheterization laboratory from the field. Demographic, laboratory, and time interval data were prospectively collected and compared with calendar year 2005 data.

Results: From June to December 2006, 80 ECGs with suspected STEMI were transmitted via the network. Twenty patients with ECGs consistent with STEMI were triaged to the catheterization laboratory. Improvement was seen in mean door-to-cardiologist notification (–14.6 vs. 61.4 min, p < 0.001), door-to-arterial access (47.6 vs. 108.1 min, p < 0.001), time-to-first angiographic injection (52.8 vs. 119.2 min, p < 0.001), and D2I times (80.1 vs. 145.6 min, p < 0.001) compared with 2005 data.

Conclusions: A fully automated wireless network that transmits ECGs simultaneously to the ED and offsite cardiologists for the early evaluation and triage of patients with suspected STEMI can decrease D2I times to <90 min and has the potential to be broadly applied in clinical practice.

Abbreviations and Acronyms   ACC/AHA = American College of Cardiology/American Heart Association   D2A = door-to-arterial access   D2B = door-to-balloon   D2I = door-to-intervention   ED = emergency department   EMS = emergency medical services   NRMI = National Registry of Myocardial Infarction   PCI = percutaneous coronary intervention   STEMI = ST-segment elevation myocardial infarction

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