Prehospital 12-Lead ECG Teletransmission in Acute Coronary Syndromes: Diagnostic, Prognostic, and Systems-of-Care Implications

Background/Objectives: Acute coronary syndrome (ACS) remains one of the leading causes of cardiovascular mortality worldwide. Rapid diagnosis and timely initiation of reperfusion therapy are crucial for improving patient outcomes. The aim of this narrative review was to summarize current evidence on prehospital 12-lead ECG teletransmission in the diagnosis and management of ACS and to evaluate its impact on systems of care and clinical outcomes. Methods: A narrative literature review was conducted using the PubMed database. The literature search was completed on 15 May 2026 and included publications from 1998 onwards. The review included studies evaluating prehospital ECG teletransmission, ST elevation myocardial infarction (STEMI) networks, interpretation models, treatment delays, and organizational and logistics aspects of ECG teletransmission systems. Current guidelines from the European Society of Cardiology and the 2025 ACC/AHA/ACEP/NAEMSP/SCAI guidelines were also included. Results: Available evidence indicates that prehospital ECG teletransmission enables earlier STEMI diagnosis, direct referral to primary coronary intervention (PCI)-capable centers, and earlier activation of catheterization laboratories. Multiple observational studies and meta-analyses have demonstrated reductions in first medical contact-to-device and door-to-device times associated with teletransmission systems. Limitations include interpretation variability, false-positive catheterization laboratory activations, and infrastructure-related barriers. Conclusions: ECG teletransmission is an essential component of contemporary regional STEMI care systems and contributes to improved organization of care and shorter reperfusion delays. Further development and prospective validation of artificial intelligence-assisted ECG interpretation and integrated telemedicine systems may enhance diagnostic accuracy and the effectiveness of prehospital cardiac care.