Objective: To study the efficacy of fast track managed care and in-hospital outcomes after applying the Applied Digital 12 leads ECG Consultation System (ADECS) to the routine ST segment elevation myocardial infarction (STEMI) fast track guideline in Saraburi Hospital.

Material and Method: The data were collected from a prospective registry of all chest discomfort patients who were admitted by STEMI fast track care between January 1, 2008 and October 31, 2010.

Results: Two hundred forty eight STEMI patients were divided into two groups (before; n = 123 and after applying ADECS; n = 125). Mean age was 62.35 + 12.85 years and 70.2% were male. Common atherosclerosis risk factors were dyslipidemia (80.2%), hypertension (71.8%) and smoking (40.7%). The agreement of STEMI diagnosis between emergency department (ED) and ward improved from moderate to good level (Kappa value = 0.602; p < 0.001 vs. 0.718; p < 0.001). Mean/median of door to needle time (DTNT) and percentage of STEMI patients receiving thrombolytic therapy who achieved DTNT within 30 minutes were significantly improved, showing 73.24 + 54.78/65 vs. 46.05 + 33.88/30 minutes; p < 0.001 and 6% vs. 50.6%; p < 0.001 respectively. Mean/median of total ischemic time (TIT) was not different, 250.13 + 139.09/225 vs. 254.21 + 163.12/226 minutes; p = 0.873 due to long symptom onset to hospital arrival time (SHAT), 176.90 + 130.08/145 vs. 208.16 + 167.38/165 minutes; p = 0.218, which corresponded to the same of all in-hospital outcomes. Only the TIT within 180 minutes could show decreasing mortality rate but statistically insignificant, 13.5% vs. 20.7%; p = 0.369. Major bleeding complication was not different between thrombolytic infusion at ward or at ED, 4.1% vs. 4.8%; p = 1.00.

Conclusion: ADECS should be included in routine fast track care and thrombolysis should be initiated infusion in Emergency Department for all STEMI patients. Short DTNT was not enough to improve in-hospital outcomes. The continuous improvement should be focused on the SHAT and routine practice with quality assessment process.

Keywords: STEMI, Fast track, Door to needle, Digital ECG, Thrombolysis