Why the study?
It was unknown whether real-time physician oversight of prehospital STEMI diagnosis improves diagnostic performance in prehospital CCL activation systems and what effect additional interpretation has on treatment delay.
Does real-time physician oversight of prehospital STEMI diagnosis reduce inappropriate catheterization laboratory activations and affect FMC-to-device times in patients with suspected STEMI?
Does real-time physician oversight of prehospital STEMI diagnosis reduce inappropriate catheterization laboratory activations and affect FMC-to-device times in patients with suspected STEMI?
Real-time physician oversight of prehospital STEMI ECGs reduces inappropriate cath lab activations but may delay first medical contact-to-device times.
Physician oversight may reduce inappropriate activations at the cost of delays; leaves open selective use in prehospital STEMI systems.
BACKGROUND: ST-elevation myocardial infarction diagnosis at first medical contact (FMC) and prehospital cardiac catheterization laboratory (CCL) activation are associated with reduced total ischemic time and therefore have become the dominant ST-elevation myocardial infarction referral method in primary percutaneous coronary intervention systems. We sought to determine whether physician oversight was associated with improved diagnostic performance in a prehospital CCL activation system and what effect the additional interpretation has on treatment delay. METHODS: Between 2012 and 2015, all patients in 2 greater Montreal catchment areas with a chief symptom of chest paint or dyspnea had an in-the-field electrocardiogram (ECG). A machine diagnosis of "acute myocardial infarction" resulted either in automatic CCL (automated cohort without oversight) or transmission of the ECG to the receiving centre emergency physician for reinterpretation before CCL activation. System performance was assessed in terms of the proportion of false positive and inappropriate activations (IA), as well as the proportion of patients with FMC-to-device times ≤ 90 minutes. RESULTS: < 0.001). There was no significant effect on the proportion of false positive activation. CONCLUSIONS: Real-time physician oversight might be associated with fewer IAs, but also appears to have a deleterious effect on FMC-to-device performance. Identifying predictors of IA could improve overall performance by selecting ECGs that merit physician oversight and streamlining others. Larger clinical studies are warranted.
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Boivin‐Proulx et al. (2020) studied this question.
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