ECG-based signal analysis technologies for evaluating patients with acute coronary syndrome: A systematic review

Background/ObjectivesTimely identification of cardiac ischemia is critical in patients with acute coronary syndrome (ACS). The first test is often the standard, resting 12-lead ECG. Given its limitations, signal analysis enhancements have been proposed. We summarize the published evidence for commercially available ECG-based signal analysis technologies.MethodsThis is a systematic review of the English-language published literature.ResultsPublished evidence meeting inclusion criteria was available for two devices: PRIME ECG and LP 3000. Meta-analysis of eight studies estimated a 68.4% sensitivity (95% CI, 35.1%–89.7%) and 91.4% specificity (CI, 83.6%–95.7%) for the PRIME ECG, compared with 40.5% sensitivity (CI, 19.6%–65.5%) and 95.0% specificity (CI, 87.9%–98.0%) for the standard 12-lead ECG.ConclusionsExisting evidence is insufficient to confidently inform the appropriate use of ECG-based signal analysis technologies for detecting ischemia or infarct in ACS. Further research is needed to determine in what circumstances, if any, these devices might precede, replace, or add to the standard ECG in test strategies for detecting ischemia or infarct in ACS.