The transtelephonic electrocardiogram-based triage is an independent predictor of decreased hospital mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

Gyorgy Papai, Gabor Csato, Ildiko Racz, Gabor Szabo, Tamas Barany, Agnes Racz, Miklos Szokol, Balazs Sarman, Istvan F. Edes, Daniel Czuriga, Rudolf Kolozsvari, I. Édes

Research output: Contribution to journalArticle

Abstract

Introduction: The transtelephonic electrocardiogram has been shown to have a great value in the management of out-of-hospital chest pain emergencies. In our previous study it not only improved the pre-hospital medical therapy and time to intervention, but also the in-hospital mortality in ST-segment elevation myocardial infarction. It was hypothesised that the higher in-hospital survival rate could be due to improved transtelephonic electrocardiogram-based pre-hospital management (electrocardiogram interpretation and teleconsultation) and consequently, better coronary perfusion of patients at the time of hospital admission. To test this hypothesis, our database of ST-segment elevation myocardial infarction patients was evaluated retrospectively for predictors (including transtelephonic electrocardiogram) that may influence in-hospital survival. Methods and results: The ST-segment elevation myocardial infarction patients were divided into two groups, namely (a) hospital death patients (n = 49) and (b) hospital survivors (control, n = 726). Regarding pre-hospital medical management, the transtelephonic electrocardiogram-based triage (odds ratio 0.48, confidence interval 0.25–0.92, p = 0.0261) and the administration of optimal pre-hospital medical therapy (acetylsalicylic acid and/or clopidogrel and glycoprotein IIb/IIIa inhibitor) were the most important independent predictors for a decreased risk in our model. At the same time, age, acute heart failure (Killip class >2), successful pre-hospital resuscitation and total occlusion of the infarct-related coronary artery before percutaneous coronary intervention were the most important independent predictors for an increased risk of in-hospital mortality. Discussion: In ST-segment elevation myocardial infarction patients, (a) an early transtelephonic electrocardiogram-based teleconsultation and triage, (b) optimal pre-hospital antithrombotic medical therapy and (c) the patency and better perfusion of the infarct-related coronary artery on hospital admission are important predictors of a lower in-hospital mortality rate.

Original languageEnglish
JournalJournal of Telemedicine and Telecare
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Triage
Percutaneous Coronary Intervention
Hospital Mortality
Electrocardiography
Remote Consultation
clopidogrel
ST Elevation Myocardial Infarction
Coronary Vessels
Perfusion
Platelet Glycoprotein GPIIb-IIIa Complex
Chest Pain
Resuscitation
Aspirin
Survivors
Emergencies
Therapeutics
Survival Rate
Heart Failure
Odds Ratio

Keywords

  • Remote consultation
  • telecardiology
  • teleconsulting
  • telemedicine

ASJC Scopus subject areas

  • Health Informatics

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The transtelephonic electrocardiogram-based triage is an independent predictor of decreased hospital mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. / Papai, Gyorgy; Csato, Gabor; Racz, Ildiko; Szabo, Gabor; Barany, Tamas; Racz, Agnes; Szokol, Miklos; Sarman, Balazs; Edes, Istvan F.; Czuriga, Daniel; Kolozsvari, Rudolf; Édes, I.

In: Journal of Telemedicine and Telecare, 01.01.2018.

Research output: Contribution to journalArticle

Papai, Gyorgy ; Csato, Gabor ; Racz, Ildiko ; Szabo, Gabor ; Barany, Tamas ; Racz, Agnes ; Szokol, Miklos ; Sarman, Balazs ; Edes, Istvan F. ; Czuriga, Daniel ; Kolozsvari, Rudolf ; Édes, I. / The transtelephonic electrocardiogram-based triage is an independent predictor of decreased hospital mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. In: Journal of Telemedicine and Telecare. 2018.
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AU - Csato, Gabor

AU - Racz, Ildiko

AU - Szabo, Gabor

AU - Barany, Tamas

AU - Racz, Agnes

AU - Szokol, Miklos

AU - Sarman, Balazs

AU - Edes, Istvan F.

AU - Czuriga, Daniel

AU - Kolozsvari, Rudolf

AU - Édes, I.

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