Table 3 Myocardial infarction

Terkelsen et al. [[35]]

European Heart Journal 2005;26(8):770–777 Reduction of treatment delay in patients with ST-elevation myocardial infarction: impact of pre-hospital diagnosis and direct referral to primary percutaneous coronary intervention

Comparative analysis of treatment delay in patients diagnosed with ST-segment elevated myocardial infarction (STEMI) during the pre-hospital period or in hospital

Treatment delay was significantly reduced in patients diagnosed during the pre-hospital period

Zanini et al. [[36]]

Journal of Cardiovascular Medicine 2008;9:570–575 Impact of prehospital diagnosis in the management of ST elevation myocardial infarction in the era of primary percutaneous coronary intervention: reduction of treatment delay and mortality

Observational study comparing STEMI patients transported with telemedicine-supported ambulance with patient diagnosed in hospital

399 patients were recruited: 136 via telemedicine, while 263 came directly to the hospital. There was significant reduction treatment delay in the telemedicine compared to the in-hospital group

This is an observational study. Randomized controlled study will be required to validate the results

Brunetti [[37]]

European Journal of Cardiovascular Prevention & Rehabilitation 2010;17:615 Telecardiology improves quality of diagnosis and reduces delay to treatment in elderly patients with acute myocardial infarction and atypical presentation

Observational study to analyse the effectiveness of telemedicine in the diagnosis of STEMI

Of the 27,841 patients recruited for the study, 534 had ECG changes consistent with STEMI. Telemedicine improved the quality of diagnosis of STEMI and also led to reduction in treatment delay

Large prospective study with statistically significant conclusions

Terkelsen et al. [[38]]

Journal of Internal Medicine 2002;252:412–420 Telemedicine used for remote prehospital diagnosing in patients suspected of acute myocardial infarction

Observational study analysing the technical feasibility of diagnosis of myocardial infarction from ECG transmitted from an ambulance over a GSM network

Of the 250 patients with ECG transmitted, 214 (86%) were technically successful. Telemedicine also reduced treatment delays

This study compared telemedicine-equipped ambulance with regular ambulance. No selection mechanism was used to decide which ambulance transport a patient

Sejersten et al [[39]]

American Journal of Cardiology 2007;11:038 Effect on treatment delay of prehospital teletransmission of 12-lead electrocardiogram to a cardiologist for immediate triage and direct referral of patients with ST-segment elevation acute myocardial infarction to primary percutaneous coronary intervention

Case-control study to determine whether treatment delays in myocardial infarction can be reduced by transmitting pre-hospital 12-lead ECG directly to cardiologist phone

Of the 243 patients enrolled in the study, 184 were referred for percutaneous coronary intervention (PCI). ECG transmission was successful in 94%. 72% of the telemedicine group underwent PCI within 90 min of 911 call compared to 13% in the historical controls

Historical controls were used for the study, indicating the possibility of bias