Effect of Prehospital Digital Electrocardiogram Transmission on Revascularization Delays and Mortality in ST-Elevation Myocardial Infarction Patients: Systematic Review and Meta-Analysis

Background 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. Methods 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. Results 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; I 2 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; i 2 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; I 2 = 0%). Conclusions 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.