Effect of Prehospital Digital Electrocardiogram Transmission on Revascularization Delays and Mortality in ST-Elevation Myocardial Infarction Patients: Systematic Review and Meta-Analysis
Bibliographic record
Abstract
BackgroundPre-hospital transmission of the 12-lead electrocardiogram (ECG) to the interventional cardiologist has become the standard of care in many ST-elevation myocardial infarction (STEMI) networks but has not been universally adopted. In this systematic review and meta-analysis, we assess the effect of pre-hospital digital ECG transmission in STEMI patients on door-to-device times, first medical contact-to-device times, and mortality.MethodsWe performed a systematic review of all English studies in MEDLINE, EMBASE and CENTRAL (from inception to July 24, 2023), comparing the effect of pre-hospital digital ECG transmission to no ECG transmission in STEMI patients. We performed a random-effects meta-analysis.ResultsWe included 17 observational studies totalling 4,306 patients. Door-to-device times were reduced by 33.3 minutes in patients with pre-hospital digital ECG transmission (95% confidence intervals (CI) -50.5, -16.2 minutes; p<0.001; I2 99%). First medical contact-to-device time was also reduced with pre-hospital digital ECG transmission (mean difference -24.7 minutes; 95% CI -37.1, -12.3 minutes; p<0.001; i2 96%). Pre-hospital digital ECG transmissions was associated with a 47% reduction in mortality compared to no pre-hospital digital ECG transmission (117/1,322 (8.9%) versus 181/1,322 (13.7%), odds ratio 0.53, 95% CI 0.40, 0.69; p < 0.001; I2 = 0%).ConclusionsPre-hospital ECG transmission in STEMI patients, coupled with a systems of care reduced door-to-device times, first medical contact-to-device times, and mortality. STEMI networks should consider these findings to advocate for pre-hospital ECG transmission within their systems of care. Pre-hospital transmission of the 12-lead electrocardiogram (ECG) to the interventional cardiologist has become the standard of care in many ST-elevation myocardial infarction (STEMI) networks but has not been universally adopted. In this systematic review and meta-analysis, we assess the effect of pre-hospital digital ECG transmission in STEMI patients on door-to-device times, first medical contact-to-device times, and mortality. We performed a systematic review of all English studies in MEDLINE, EMBASE and CENTRAL (from inception to July 24, 2023), comparing the effect of pre-hospital digital ECG transmission to no ECG transmission in STEMI patients. We performed a random-effects meta-analysis. We included 17 observational studies totalling 4,306 patients. Door-to-device times were reduced by 33.3 minutes in patients with pre-hospital digital ECG transmission (95% confidence intervals (CI) -50.5, -16.2 minutes; p<0.001; I2 99%). First medical contact-to-device time was also reduced with pre-hospital digital ECG transmission (mean difference -24.7 minutes; 95% CI -37.1, -12.3 minutes; p<0.001; i2 96%). Pre-hospital digital ECG transmissions was associated with a 47% reduction in mortality compared to no pre-hospital digital ECG transmission (117/1,322 (8.9%) versus 181/1,322 (13.7%), odds ratio 0.53, 95% CI 0.40, 0.69; p < 0.001; I2 = 0%). Pre-hospital ECG transmission in STEMI patients, coupled with a systems of care reduced door-to-device times, first medical contact-to-device times, and mortality. STEMI networks should consider these findings to advocate for pre-hospital ECG transmission within their systems of care.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.009 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".