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Agreement between cardiologists and fellows in interpretation of ischemic electrocardiographic changes in acute

Jyri K Koivumäki1, Kjell C Nikus1, Heini Huhtala2

  • 1Tays Heart Hospital, Tampere University Hospital, and Medical School, Tampere University, Tampere, Finland.

Journal of Electrocardiology
|January 11, 2015
PubMed

Insights

Electrocardiogram (ECG) patterns for pre-infarction syndrome (PIS) and evolving myocardial infarction (EMI) are reliably identified by cardiologists and can be adopted by junior doctors for acute ST-elevation myocardial infarction (STEMI) treatment.

Area of Science:

  • Cardiology
  • Medical Diagnostics

Background:

  • Timing of symptom onset is not always optimal for selecting reperfusion therapy in acute ST-elevation myocardial infarction (STEMI).
  • Electrocardiogram (ECG)-based methods are being developed to aid in treatment decisions for STEMI.

Purpose of the Study:

  • To evaluate the inter-observer agreement in identifying ECG findings of pre-infarction syndrome (PIS) and evolving myocardial infarction (EMI).
  • To assess the reliability of PIS and EMI ECG pattern identification by both experienced cardiologists and junior doctors.

Main Methods:

  • 353 STEMI patients' ECGs were independently analyzed by cardiologists, cardiology fellows, internal medicine fellows, and medical students.
  • A half-hour introduction to the PIS/EMI algorithm was provided to junior doctors and medical students.
  • Inter-observer reliability was assessed using kappa statistics.

Main Results:

  • Good inter-observer reliability (κ 0.632-0.790) was observed for the entire study population.
  • Reliability was good to very good between experienced cardiologists and cardiology fellows (κ 0.652 -0.813).
  • Moderate to good reliability (κ 0.464-0.784) was found between junior doctors/medical students and experienced clinicians.

Conclusions:

  • Pre-infarction syndrome (PIS) and evolving myocardial infarction (EMI) ECG patterns are reliably identified by experienced cardiologists.
  • These ECG patterns can be readily adopted and utilized by junior doctors, improving STEMI diagnosis and management.
Abstract

Keywords:
Ischemic electrocardiographic changesSTEMI

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