Journal article
Prospective validation of current quantitative electrocardiographic criteria for ST-elevation myocardial infarction.
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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.
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Strebel I
Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
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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.
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Twerenbold R
Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
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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.
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Bernhard D
Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
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Nestelberger T
Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
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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.
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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.
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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.
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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.
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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.
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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.
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Rubini Gimenez M
Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
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du Fay de Lavallaz J
Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
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Walter J
Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
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Geigy N
Emergency Department, Kantonsspital Liestal, Switzerland.
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Keller DI
Emergency Department, University Hospital Zurich, Zurich, Switzerland.
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Reichlin T
Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
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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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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.
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Language
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Open access status
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closed
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Identifiers
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Persistent URL
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https://folia.unifr.ch/global/documents/267127
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