P212 - IMPACT OF A CLOUD-BASED CARE COORDINATION PLATFORM ON TREATMENT DELAYS FOR STEMI PATIENTS IDENTIFIED IN THE FIELD AND TRANSFERRED DIRECTLY TO CATH LAB WITHIN A HUB-AND-SPOKE SYSTEM

Background: In ST-elevation myocardial infarction (STEMI), rapid diagnosis and cardiac catheterization lab (cath lab) activation are critical to achieve prompt coronary reperfusion. The Stenoa platform allows for communication between emergency medical services (EMS), emergency room (ER) physicians, and interventional cardiologists, to enable direct coordination of STEMI patient care. This study assessed the impact of Stenoa on treatment delays for STEMI patients transferred from the Suroît region within a hub-and-spoke system.

METHODS AND RESULTS: Stenoa is a cloud-based care coordination platform approved by the Québec Ministry of Health, introduced at the McGill University Health Centre (MUHC) in September 2021 and later expanded to the Suroît region. A retrospective cohort study was conducted to compare STEMI treatment delays before (March 2020–September 2021) and after (September 2021–May 2024) Stenoa implementation. Treatment delays were analyzed across three groups: Group 1 (direct EMS transfer from the field in the Suroît region to MUHC cath lab), Group 2 (Suroît ER to MUHC cath lab), and Group 3 (EMS to Suroît ER, then to MUHC cath lab). Only group 1 was included in this sub-analysis. The primary outcome was First Medical Contact (FMC)-to-reperfusion time. Intermediary delays within the STEMI activation sequence were also assessed.

A total of 222 STEMI patients were identified, with a mean age of 64±13 years, and 75% were male. Groups 1, 2 and 3 consisted of 127, 61, and 34 patients, respectively. Median delays were significantly reduced in group 1 after Stenoa implementation, including FMC to reperfusion (99.0 to 86.5 minutes; p=0.002) and FMC to cath lab activation (27.0 to 19.5 minutes; p< 0.001). The proportion of patients achieving reperfusion within the target of 120 minutes increased from 79.7% to 97.8% (p=0.005). In a multivariate model, independent predictors of FMC-to-reperfusion were: use of the Stenoa platform (-13.5 minutes; p=0.004), male sex (-11.2 minutes; p=0.017) and presentation during daytime hours (-9.8 minutes p=0.013).

Conclusion: The Stenoa platform significantly reduced treatment delays for STEMI patients identified in the field and transferred to the cath lab within a hub-and-spoke system, thereby improving emergency cardiac care. These results highlight the potential of digital tools in enhancing STEMI outcomes and underscore the need for further research in this area.