Reducing Delay to Treatment of ST-Elevation Myocardial Infarction with Software Electrocardiographic Interpretation and Transmission (SCINET)

Abstract Background Pre-hospital diagnosis of ST-elevation myocardial infarction (STEMI) has resulted in improved outcomes. Many patients however still walk-in to the Emergency Department (ED) with STEMI, experiencing delays and worse outcomes. Software ECG diagnosis of STEMI and electronic transmission to a Cardiologist may result in improved door-to-device (D2D) times. Methods We retrospectively identified all patients presenting with STEMI from January 2015-September 2016. Components of delay in D2D, ED variables, and the patients’ ECGs were extracted from our regional database. All ECGs performed for suspected MI in the region were extracted over the study period. We assessed the accuracy of the software 12SL in diagnosing STEMI, ED contributors to delays in D2D, as well as the potential reduction in D2D if software diagnosis of STEMI resulted in activation of the CCL. Results 379 patients presented to an ED in our region and received primary PCI over the study period. In the 143,574 ECGs performed over the study period for suspected STEMI, the overall sensitivity and specificity of 12SL were 90.5% and 99.98% respectively. We estimated a potential 17-minute reduction in D2D in the 90.5% of patients correctly identified as STEMI, with a false activation rate of 4%. Female patients and older patients experienced an even larger potential benefit, with a 24- and 25-minute reduction in D2D respectively. Conclusions Patients who walk-in to an ED with STEMI experience significant system-related delays in recognition and treatment. Automated software diagnosis of STEMI is accurate and could result in significant improvements in D2D times.