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A tale of two cities: STEMI interventions in developed and developing countries and the potential of telemedicine to reduce disparities in care.

OBJECTIVES
To utilize telemedicine as a foundation platform for creating population-based STEMI networks.


BACKGROUND
Disparate acute myocardial infarction (AMI) management occurs in developed and developing countries on account of differences in infrastructure resources. As a result, developed countries utilize primary percutaneous coronary intervention (PCI) and second- and third-generation thrombolytic therapy, in contrast to developing countries, which primarily rely on earlier-generation thrombolytic therapy and basic medical management. Reducing the vast gap in AMI care between developed and developing countries is an abysmally slow process.


METHODS
Remote access, telemedicine IT platforms, expert EKG interpretation, teleconsultation, and a strict quality assurance process are incorporated into a population-based AMI network.


RESULTS
Lumen Americas Telemedicine Infarct Network (LATIN) is an applied hub-and-spoke strategy, which creates a telemedicine-based STEMI management network across large populations. Primary PCI with targeted door-to-balloon times is the preferred strategy for the hub sites. Telemedicine-guided accurate EKG interpretation and teleconsultation are applied at the spoke sites. An integrated IT platform is used to navigate an effective prehospital triage system. The pilot phase has created 100 LATIN sites in Brazil and Colombia.


CONCLUSION
Telemedicine provides an attractive strategy to reduce the gaps that presently exist in managing AMI in developed and developing countries.