Physician accuracy in interpreting potential ST-segment elevation myocardial infarction electrocardiograms.

Area of Science:

• Cardiology
• Medical Diagnostics
• Telemedicine

Background:

• Increasing use of telemedicine requires physicians to interpret electrocardiograms (ECGs) for ST-segment elevation myocardial infarctions (STEMIs) with limited clinical data.
• Assessing physician diagnostic agreement and accuracy for STEMI interpretation from ECGs is crucial.

Purpose of the Study:

• To evaluate the diagnostic agreement and accuracy of physicians interpreting ECGs for potential STEMIs.
• To determine if ECGs alone are sufficient for STEMI diagnosis in a telemedicine context.

Main Methods:

• A cross-sectional survey involving 124 physicians (emergency physicians, cardiologists, interventional cardiologists).
• Participants interpreted 36 deidentified ECGs with prior putative STEMI diagnoses.
• Reference standard was emergent coronary arteriography; statistical analysis used generalized estimating equations.

Main Results:

• Interreader agreement for ECG interpretation was poor (kappa = 0.33).
• Sensitivity for identifying STEMIs was 65%, and specificity was 79%.
• Physician experience correlated positively with accurate interpretation, but specialty did not significantly impact accuracy.

Conclusions:

• Significant disagreement exists among physicians when interpreting ECGs for potential STEMIs.
• ECGs lack sufficient sensitivity and specificity to serve as a standalone diagnostic tool for STEMI.