Reducing Delay to Treatment of ST-Elevation Myocardial Infarction With Software Electrocardiographic Interpretation
Justin M Cloutier1, Christopher Hayes1, John Ducas1
1Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Insights
Automated software diagnosis of ST-elevation myocardial infarction (STEMI) is accurate. Implementing this technology in emergency departments can significantly reduce door-to-device times for STEMI patients, improving outcomes.
Area of Science:
- Cardiology
- Medical Technology
- Emergency Medicine
Background:
- Prehospital diagnosis of ST-elevation myocardial infarction (STEMI) improves outcomes, but many patients still face delays upon arrival at the emergency department (ED).
- Software-based electrocardiogram (ECG) diagnosis and electronic transmission to cardiologists show potential for reducing delays in STEMI treatment.
- Emergency department (ED) presentation of STEMI can lead to delayed treatment and worse patient outcomes.
Purpose of the Study:
- To assess the accuracy of a specific software (12SL) in diagnosing STEMI from ECGs.
- To identify factors contributing to delays in door-to-device (D2D) times for STEMI patients in the ED.
- To evaluate the potential reduction in D2D times if software diagnosis of STEMI triggered immediate cardiac catheterization laboratory activation.
Main Methods:
- Retrospective analysis of STEMI patients from January 2015 to September 2016.
- Extraction of D2D delay components, ED variables, and ECG data from a regional database.
- Assessment of software 12SL accuracy for STEMI diagnosis and simulation of D2D time reduction with automated activation.
Main Results:
- The software 12SL demonstrated high accuracy in diagnosing STEMI, with 90.5% sensitivity and 99.98% specificity.
- An estimated 17-minute reduction in D2D time was possible for 90.5% of correctly identified STEMI patients, with a 4% false activation rate.
- Female and older patients could experience even greater D2D time reductions (24 and 25 minutes, respectively).
Conclusions:
- Patients with STEMI presenting to the ED experience significant system-related delays.
- Automated software diagnosis of STEMI is accurate and can substantially decrease D2D times.
- This technology offers a promising strategy to improve treatment efficiency and outcomes for STEMI patients.
Background:
Prehospital diagnosis of ST-elevation myocardial infarction (STEMI) has resulted in improved outcomes. However, many patients still walk in to the emergency department (ED) with STEMI, experiencing delays and worse outcomes. Software electrocardiogram (ECG) diagnosis of STEMI and electronic transmission to a cardiologist may result in improved door-to-device (D2D) times.
Methods:
We retrospectively identified all patients presenting with STEMI from January 2015 to September 2016. Components of delay in D2D, ED variables, and the patients' ECGs were extracted from our regional database. All ECGs performed for suspected myocardial infarction in the region were extracted over the study period. We assessed the accuracy of the software 12SL in diagnosing STEMI, ED contributors to delays in D2D, and the potential reduction in D2D if software diagnosis of STEMI resulted in activation of the cardiac catheterization laboratory.
Results:
A total of 379 patients presented to an ED in our region and received primary percutaneous coronary intervention over the study period. In the 143,574 ECGs performed over the study period for suspected STEMI, the overall sensitivity and specificity of 12SL were 90.5% and 99.98%, respectively. We estimated a potential 17-minute reduction in D2D in the 90.5% of patients correctly identified as having STEMI, with a false activation rate of 4%. Female patients and older patients experienced an even larger potential benefit, with 24- and 25-minute reductions in D2D, respectively.
Conclusions:
Patients who walk in to an ED with STEMI experience significant system-related delays in recognition and treatment. Automated software diagnosis of STEMI is accurate and could result in significant improvements in D2D times.
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