Efax STEMI study. Accuracy of interpreting fax to email ST-elevation myocardial infarction electrocardiograms viewed on smartphones

We aimed to compare the accuracy of reviewing electronically faxed STEMI ECG's on smart phones with viewing of printed ECG's that are transmitted via traditional fax service. 120 STEMI ECG's, which were confirmed as true STEMIs from coronary angiography and 200 consecutive NSTEMI ECG's of patients who underwent coronary angiography at a major teaching hospital were sent in a randomised fashion via a fax to email service (eFax) in PDF to be viewed directly on a smartphone with 5'+ HD screen. The transmitted ECG's were interpreted by two independent and blinded cardiologists and classified as STEMI, including infarct territory, NSTEMI or LBBB. Four weeks later, the same cardiologists interpreted the paper ECG's. The results were compared and correlated with cardiac catheterisation findings. Of the 120 STEMI ECG's, the two cardiologists were able to correctly identify all 120 ECGs as STEMIs both when viewed as PDF on a smartphone and when viewing the printed ECG. The overall agreement between smartphone viewed ECGs and the printed ECGs was 100%. Localisation of infarct territory was then correlated with cardiac catheterisation findings and showed a 79% correlation on smartphone viewed ECG's compared to 80% with printed ECG's. ECG's transmitted via eFax compared to traditional fax can be viewed in a more timely fashion. Coupled with the fact that the STEMI pick up rate is equivalent, and the localisation of STEMI was equivalent, we postulate that this may lead to improved clinical outcomes in patients presenting with STEMI to emergency.