Background

The 12‑lead ECG plays an important role in triaging patients with symptomatic coronary artery disease, making automated ECG interpretation statements of “Acute MI” or “Acute Ischemia” crucial, especially during prehospital transport when access to physician interpretation of the ECG is limited. However, it remains unknown how automated interpretation statements correspond to adjudicated clinical outcomes during hospitalization. We sought to evaluate the diagnostic performance of prehospital automated interpretation statements to four well-defined clinical outcomes of interest: confirmed ST- segment elevation myocardial infarction (STEMI); presence of actionable coronary culprit lesions, myocardial necrosis, or any acute coronary syndrome (ACS).

Methods

An observational cohort study that enrolled consecutive patients with non-traumatic chest pain transported via ambulance. Prehospital ECGs were obtained with the Philips MRX monitor from the medical command center and re-processed using manufacturer-specific diagnostic algorithms to denote the likelihood of >> > Acute MI < << or >> > Acute Ischemia<<<. Two independent reviewers retrospectively adjudicated the study outcomes and disagreements were resolved by a third reviewer.

Results

Our study included 2400 patients (age 59 ± 16, 47% females, 41% Black), with 190 (8%) patients with documented automated diagnostic statements of acute MI or acute ischemia. The sensitivity/specificity of the automated algorithm for detecting confirmed STEMI (n = 143, 6%); presence of actionable coronary culprit lesions (n = 258, 11%), myocardial necrosis (n = 291, 12%), or any ACS (n = 378, 16%) were 62.9%/95.6%; 37.2%/95.6%; 38.5%/96.4%; and 30.7%/96.3%, respectively.

Conclusion

Although being very specific, automated interpretation statements of acute MI/acute ischemia on prehospital ECGs are not satisfactorily sensitive to exclude symptomatic coronary disease. Patients without these automated interpretation statements should be considered further for significant underlying coronary disease based on the clinical context.

Trial registration

ClinicalTrials.gov # NCT04237688

中文翻译：

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疑似急性冠状动脉综合征患者自动心电图解释语句的性能和局限性

背景

12 导联心电图在分流有症状的冠状动脉疾病患者中发挥着重要作用，因此“急性心肌梗死”或“急性缺血”的自动心电图解释语句至关重要，尤其是在院前转运过程中，当医生对心电图的解释有限时。然而，目前尚不清楚自动解释语句如何与住院期间的裁定临床结果相对应。我们试图评估院前自动解释语句对四种明确定义的感兴趣临床结果的诊断性能：确诊的 ST 段抬高型心肌梗死 (STEMI)；存在可治疗的冠状动脉罪犯病变、心肌坏死或任何急性冠状动脉综合征 (ACS)。

方法

一项观察性队列研究，纳入了通过救护车运送的连续非创伤性胸痛患者。使用飞利浦 MRX 监护仪从医疗指挥中心获得院前心电图，并使用制造商特定的诊断算法进行重新处理，以表示 >>> 急性心肌梗死 <<< 或 >>> 急性缺血<<< 的可能性。两名独立评审员对研究结果进行了回顾性裁决，分歧由第三名评审员解决。

结果

我们的研究包括 2400 名患者（年龄 59 ± 16 岁，47% 为女性，41% 为黑人），其中 190 名 (8%) 患者记录了急性心肌梗死或急性缺血的自动诊断声明。检测确诊 STEMI 的自动化算法的敏感性/特异性（n  = 143, 6%）；存在可治疗的冠状动脉罪犯病变 ( n  = 258, 11%)、心肌坏死 ( n  = 291, 12%) 或任何 ACS ( n  = 378, 16%) 分别为 62.9%/95.6%；37.2%/95.6%；38.5%/96.4%；分别为 30.7%/96.3%。

结论

虽然非常具体，但院前心电图上的急性心肌梗死/急性缺血的自动解释声明对于排除症状性冠状动脉疾病的敏感性并不令人满意。没有这些自动解释语句的患者应根据临床情况进一步考虑是否存在明显的潜在冠状动脉疾病。

试用注册

ClinicalTrials.gov #NCT04237688