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

Aged Aged, 80 and over Electrocardiography Female Humans Male Middle Aged Prospective Studies ST Elevation Myocardial Infarction / diagnosis
Diagnostic accuracy ECG criteria STEMI Software-based measurement

Journal

International journal of cardiology
ISSN: 1874-1754
Titre abrégé: Int J Cardiol
Pays: Netherlands
ID NLM: 8200291

Informations de publication

Date de publication:
01 10 2019
Historique:
received: 03 03 2019
revised: 06 04 2019
accepted: 11 04 2019
pubmed: 6 5 2019
medline: 26 6 2020
entrez: 7 5 2019
Statut: ppublish

Résumé

Rapid and reliable diagnosis of ST-elevation myocardial infarction (STEMI) as a surrogate for acute coronary occlusion is critical for early reperfusion therapy. We aimed to examine the diagnostic performance of current guideline-recommended Electrocardiogram (ECG) STEMI criteria. 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. 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%. 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. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00470587.

Sections du résumé

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.

Identifiants

DOI: 10.1016/j.ijcard.2019.04.041 PMID: 31056411
pubmed: 31056411
pii: S0167-5273(19)31164-7
doi: 10.1016/j.ijcard.2019.04.041
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT00470587']

Types de publication

Journal Article Multicenter Study Validation Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

1-12

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2019 Elsevier B.V. All rights reserved.

Auteurs

Petra 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.

Ivo Strebel (I)

Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.

Roger 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.

Raphael Twerenbold (R)

Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.

Karin 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.

Denise Bernhard (D)

Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.

Thomas Nestelberger (T)

Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.

Jasper 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.

Patrick 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.

Desiree 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.

Luca 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.

Tobias 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.

Christian 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.

Maria Rubini Gimenez (M)

Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.

Jeanne du Fay de Lavallaz (J)

Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.

Joan Walter (J)

Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.

Nicolas Geigy (N)

Emergency Department, Kantonsspital Liestal, Switzerland.

Dagmar I Keller (DI)

Emergency Department, University Hospital Zurich, Zurich, Switzerland.

Tobias Reichlin (T)

Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.

Christian 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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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Prospective validation of current quantitative...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Prospective validation of current quantitative...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Électrodiagnostic › Électrocardiographie › Prospective validation of current quantitative...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Prospective validation of current quantitative...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Prospective validation of current quantitative...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Prospective validation of current quantitative...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Nécrose › Infarctus › Infarctus du myocarde › Infarctus du myocarde avec sus-décalage du segment ST › Prospective validation of current quantitative...