Reducing Delay to Treatment of ST-Elevation Myocardial Infarction With Software Electrocardiographic Interpretation and Transmission (SCINET)

• Published in: CJC open (Online) 2020-05, Vol.2 (3), p.111-117
• Main Authors: Cloutier, Justin M., Hayes, Christopher, Ducas, John, Allen, David W.
• Format: Article
• Language: English
• Subjects: Original
• ISSN: 2589-790X; 2589-790X
• DOI: 10.1016/j.cjco.2020.02.003

Prehospital diagnosis of ST-elevation myocardial infarction (STEMI) has resulted in improved outcomes. However, many patients still walk in to the emergency department (ED) with STEMI, experiencing delays and worse outcomes. Software electrocardiogram (ECG) diagnosis of STEMI and electronic transmission to a cardiologist may result in improved door-to-device (D2D) times. We retrospectively identified all patients presenting with STEMI from January 2015 to September 2016. Components of delay in D2D, ED variables, and the patients’ ECGs were extracted from our regional database. All ECGs performed for suspected myocardial infarction in the region were extracted over the study period. We assessed the accuracy of the software 12SL in diagnosing STEMI, ED contributors to delays in D2D, and the potential reduction in D2D if software diagnosis of STEMI resulted in activation of the cardiac catheterization laboratory. A total of 379 patients presented to an ED in our region and received primary percutaneous coronary intervention over the study period. In the 143,574 ECGs performed over the study period for suspected STEMI, the overall sensitivity and specificity of 12SL were 90.5% and 99.98%, respectively. We estimated a potential 17-minute reduction in D2D in the 90.5% of patients correctly identified as having STEMI, with a false activation rate of 4%. Female patients and older patients experienced an even larger potential benefit, with 24- and 25-minute reductions in D2D, respectively. Patients who walk in to an ED with STEMI experience significant system-related delays in recognition and treatment. Automated software diagnosis of STEMI is accurate and could result in significant improvements in D2D times. Le diagnostic préhospitalier de l’infarctus du myocarde avec élévation du segment ST (STEMI) contribue à améliorer les résultats pour les patients. Toutefois, de nombreux patients subissant un STEMI se présentent encore d’eux-mêmes au service des urgences, ce qui retarde leur traitement et entraîne des conséquences plus graves. Le diagnostic de STEMI au moyen d’un logiciel de prise d’électrocardiogramme (ECG) qui est ensuite transmis à un cardiologue par voie électronique pourrait réduire le délai entre l’arrivée à l’hôpital et la pose d’un dispositif (délai avant l’intervention). Nous avons rétrospectivement recensé tous les patients ayant subi un STEMI entre janvier 2015 et septembre 2016. Les facteurs entraînant l’augmentation du délai avant l’intervention