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

Petra Hillinger1, Ivo Strebel2, Roger Abächerli3

  • 1Department 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.

International Journal of Cardiology
|May 7, 2019
PubMed

Insights

Current Electrocardiogram (ECG) criteria for ST-elevation myocardial infarction (STEMI) show suboptimal diagnostic performance. Automated analysis revealed low sensitivity and positive predictive value for STEMI diagnosis in the emergency department.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Emergency Medicine

Background:

  • Rapid diagnosis of ST-elevation myocardial infarction (STEMI) is crucial for timely reperfusion therapy.
  • STEMI diagnosis often relies on Electrocardiogram (ECG) criteria.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of current guideline-recommended ECG criteria for STEMI.
  • To assess the performance of automated ECG analysis in identifying STEMI.

Main Methods:

  • Prospective, multicenter diagnostic study involving adult patients with suspected myocardial infarction (MI).
  • Objective quantification of ST-segment elevation using automated software analysis of digital 12-lead ECGs.
  • Comparison of ECG criteria against final adjudicated diagnoses by cardiologists.

Main Results:

  • Only 35% of final STEMI cases were correctly identified by current ECG criteria (Sensitivity 35%, PPV 54%).
  • Suboptimal diagnostic performance was attributed to timing, measurement points, borderline ST-segment elevation, and inferoposterior MI location.
  • High Negative Predictive Value (NPV 97.8%) indicates current criteria are good at ruling out STEMI.

Conclusions:

  • Current guideline-recommended ECG criteria for STEMI exhibit suboptimal diagnostic performance when applied to a single ECG at emergency department presentation.
  • Automated ECG analysis highlights limitations in current criteria, necessitating further research for improved STEMI detection.
Abstract

Keywords:
Diagnostic accuracyECG criteriaSTEMISoftware-based measurement

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