What's the point of ST elevation?
S D Carley1, R Gamon, P A Driscoll
1Department of Emergency Medicine, Manchester Royal Infirmary, UK. s.carley@btinternet.com
Insights
Assessing ST elevation for acute myocardial infarction treatment varies widely among doctors. Inconsistent measurement points lead to unreliable ST elevation magnitude, potentially impacting thrombolysis decisions.
Area of Science:
- Cardiology
- Emergency Medicine
- Medical Education
Background:
- ST elevation on electrocardiograms (ECGs) is crucial for diagnosing acute myocardial infarction (AMI) and guiding thrombolysis decisions.
- The reliability of clinicians' ST elevation assessment has not been previously evaluated.
- Variability in ST elevation measurement could affect treatment protocols.
Purpose of the Study:
- To assess the variability in ST elevation measurement among physicians who commonly prescribe thrombolysis.
- To identify inconsistencies in how ST elevation is quantified on ECGs.
Main Methods:
- A study involving 63 junior doctors (Senior House Officers and Specialist Registrars) from emergency and general medicine across three UK teaching hospitals.
- Participants were presented with three ECG complexes and asked to identify, quantify ST elevation, and indicate the measurement points.
- A convenience sampling method was employed.
Main Results:
- ST elevation was missed in 12% of cases reviewed.
- Significant variation was observed in the points used by doctors to measure ST elevation.
- This inconsistency resulted in a wide range of reported ST elevation magnitudes.
Conclusions:
- There is a lack of standardized guidance on the precise anatomical landmarks for measuring ST elevation on ECGs.
- The study highlights considerable variability in clinical practice for assessing ST elevation.
- These findings may compromise the effectiveness of protocol-driven thrombolysis decision-making pathways in acute myocardial infarction.
Objective:
The magnitude of ST elevation is a key piece of information in the decision to thrombolyse in acute myocardial infarction. The ability of clinicians to reliably identify ST elevation has not been previously assessed. This study sought to determine the variability in assessment of ST elevation in a group of doctors who commonly prescribe thrombolysis.
Methods:
The study was conducted in three large teaching hospitals in Manchester, England. A convenience sample of 63 SHOs and SpRs from emergency and general medicine were recruited. Each was shown three sample ECG complexes. They were asked to identify and quantify the degree of ST elevation. They then indicated the points on the ECG from which they measured ST elevation.
Results:
ST elevation was not identified in 12% of cases. Doctors used a wide variety of points on the ST segment to assess elevation, this resulted in a wide variation in the observed magnitude of ST elevation.
Conclusion:
No guidance exists on where exactly ST elevation should be measured. This study shows a wide variation in practice. Protocol led thrombolysis decision pathways may be compromised by these findings.
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