Prospective validation of current quantitative electrocardiographic criteria for ST-elevation myocardial infarction.
Journal article

Prospective validation of current quantitative electrocardiographic criteria for ST-elevation myocardial infarction.

  • Hillinger P Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Anesthesia and Intensive Care Medicine, University Hospital Innsbruck, University of Innsbruck, Austria.
  • Strebel I Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
  • Abächerli R Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Institute of Medical Engineering, Lucerne University of Applied Sciences and Arts, Horw, Switzerland.
  • Twerenbold R Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
  • Wildi K Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Anesthesia, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.
  • Bernhard D Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
  • Nestelberger T Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
  • Boeddinghaus J Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, Switzerland.
  • Badertscher P Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Division of Cardiology, University of Illinois at Chicago, Chicago, United States.
  • Wussler D Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, Switzerland.
  • Koechlin L Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Cardiac Surgery, University Hospital Basel, Switzerland.
  • Zimmermann T Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, Switzerland.
  • Puelacher C Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, Switzerland.
  • Rubini Gimenez M Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
  • du Fay de Lavallaz J Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
  • Walter J Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
  • Geigy N Emergency Department, Kantonsspital Liestal, Switzerland.
  • Keller DI Emergency Department, University Hospital Zurich, Zurich, Switzerland.
  • Reichlin T Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
  • Mueller C Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland. Electronic address: Christian.Mueller@usb.ch.
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  • 2019-05-07
Published in:
  • International journal of cardiology. - 2019
English BACKGROUND
Rapid and reliable diagnosis of ST-elevation myocardial infarction (STEMI) as a surrogate for acute coronary occlusion is critical for early reperfusion therapy.


OBJECTIVES
We aimed to examine the diagnostic performance of current guideline-recommended Electrocardiogram (ECG) STEMI criteria.


METHODS
In a prospective diagnostic multicenter study, we objectively quantified the extent of ST-segment elevation in all ECG leads using an automated software-based analysis of the digital 12-lead-ECG in adult patients presenting to the emergency department (ED) with suspected myocardial infarction (MI). Classification according to current guideline-recommended ECG criteria for STEMI at ED presentation was compared against a final diagnosis adjudicated by two independent cardiologists after reviewing all available medical records including serial ECGs, cardiac imaging and coronary angiograms.


RESULTS
Among 2486 patients, 52 (2%) were found to have significant ST-segment elevation on ECG at ED presentation according to current guideline-recommended ECG criteria for STEMI. Eighty-one (3%) patients received a final adjudicated diagnosis of STEMI. Only 35% (28 of 81) of all patients with a final diagnosis of STEMI were correctly identified (PPV 54% (95% CI 41-66%), sensitivity 35% (95% Cl 24-46%), NPV 97.8% (95% CI 97.5-98.1%). Four reasons for missing STEMIs emerged: timing (significant STE at an earlier/later time point) in 25%, incorrect measurement points in 30%, non or borderline-significant STE in 36% and inferoposterior MI localisation in 9%.


CONCLUSIONS
A computerized analysis of current guideline-recommended ECG criteria for STEMI showed suboptimal diagnostic performance when applied to a single 12‑lead ECG performed at ED presentation.


CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00470587.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://folia.unifr.ch/global/documents/267127
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