Prospective validation of current quantitative electrocardiographic criteria for ST-elevation myocardial infarction
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Prospective validation of current quantitative electrocardiographic criteria for ST-elevation myocardial infarction. / APACE Investigators.
in: INT J CARDIOL, Jahrgang 292, 01.10.2019, S. 1-12.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Prospective validation of current quantitative electrocardiographic criteria for ST-elevation myocardial infarction
AU - Hillinger, Petra
AU - Strebel, Ivo
AU - Abächerli, Roger
AU - Twerenbold, Raphael
AU - Wildi, Karin
AU - Bernhard, Denise
AU - Nestelberger, Thomas
AU - Boeddinghaus, Jasper
AU - Badertscher, Patrick
AU - Wussler, Desiree
AU - Koechlin, Luca
AU - Zimmermann, Tobias
AU - Puelacher, Christian
AU - Rubini Gimenez, Maria
AU - du Fay de Lavallaz, Jeanne
AU - Walter, Joan
AU - Geigy, Nicolas
AU - Keller, Dagmar I
AU - Reichlin, Tobias
AU - Mueller, Christian
AU - APACE Investigators
N1 - Copyright © 2019 Elsevier B.V. All rights reserved.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - 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.
AB - 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.
KW - Aged
KW - Aged, 80 and over
KW - Electrocardiography
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Prospective Studies
KW - ST Elevation Myocardial Infarction/diagnosis
U2 - 10.1016/j.ijcard.2019.04.041
DO - 10.1016/j.ijcard.2019.04.041
M3 - SCORING: Journal article
C2 - 31056411
VL - 292
SP - 1
EP - 12
JO - INT J CARDIOL
JF - INT J CARDIOL
SN - 0167-5273
ER -
