In patients with an acute coronary syndrome (ACS), prehospital transmission of the ECG offers the potential to reduce the time delay between symptom onset and initiation of treatment. However, the effect of this telemedicine intervention on clinical outcomes has not been well validated. In a systematic review and meta-analysis, Marcolino and colleagues1 identified 30 non-randomised controlled and 7 quasi-experimental studies of telemedicine for ACS that included a total of almost 17 000 patients. In these studies, prehospital ECG transmission (compared with usual care) was associated with a lower in-hospital mortality (relative risk (RR) 0.63 (95% CI 0.55 to 0.72)), door-to-balloon time (mean difference –28 min (95% CI –35 to –20)), 30-day and long-term mortality (RR 0.61 (95% CI 0.40 to 0.92)) (figure 1). However, there was moderate to large heterogeneity for all these findings suggesting that more rigorous evaluation of telemedicine strategies for improving outcome is…

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