AI-Assisted Electrocardiogram Interpretation Improves ST-Elevation Myocardial Infarction Diagnostic Accuracy Among
Richard Palomino1, Matthew J Perdue1,2, Alec Pawlukiewicz1
1Department of Emergency Medicine, Carl R. Darnall Army Medical Center, Fort Hood, TX 76544, United States.
Military Medicine
|August 4, 2026
Summary
Artificial intelligence (AI) electrocardiogram (ECG) interpretation significantly improved ST-elevation myocardial infarction (STEMI) diagnosis and confidence among advanced practice providers. The AI tool enhanced accuracy without clinically meaningful delays, supporting its use in critical care settings.
Area of Science:
- Cardiology
- Medical Artificial Intelligence
- Clinical Decision Support
Background:
- Accurate ST-elevation myocardial infarction (STEMI) diagnosis is crucial in military settings.
- Artificial intelligence (AI) electrocardiogram (ECG) tools show promise but require evaluation among advanced practice providers (APPs).
Purpose of the Study:
- To evaluate the impact of AI-ECG interpretation on STEMI diagnostic accuracy, clinician confidence, and time-to-decision among APPs.
- To assess the effectiveness of PMcardio's Queen of Hearts (QoH) AI software in a military medical environment.
Main Methods:
- Prospective, randomized, multi-reader, multi-case crossover study with 21 certified physician assistants (PA-Cs).
- Participants interpreted 50 ECGs (25 STEMI, 25 non-STEMI) with and without AI assistance.
- Primary outcome: diagnostic accuracy; Secondary outcomes: confidence and time-to-decision.
Main Results:
- AI-ECG interpretation significantly improved diagnostic accuracy (92.9% vs. 79.0%, P < .001).
- Sensitivity increased to 95.4% and specificity to 90.5% with AI assistance.
- Clinician confidence improved significantly (lower Likert scores), and interrater agreement rose from moderate to excellent.
Conclusions:
- AI-assisted ECG interpretation enhances STEMI diagnostic accuracy and clinician confidence in APPs.
- The modest increase in time-to-decision with AI is unlikely to be clinically significant.
- AI-ECG decision-support tools are suitable for frontline and operational settings to improve STEMI recognition.
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An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin to...
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
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