Agreement between cardiologists and fellows in interpretation of ischemic electrocardiographic changes in acute myocardial infarction

- We show that the PIS and EMI ECG patterns are reliably identified by cardiologists.
- The classification can easily be adopted by junior doctors.
- Using this classification may be helpful when choosing reperfusion strategy.

BackgroundTime from symptom onset may not be the best indicator for choosing reperfusion therapy for patients presenting with acute ST-elevation myocardial infarction (STEMI); consequently ECG-based methods have been developed.MethodsThis study evaluated the inter-observer agreement between experienced cardiologists and junior doctors in identifying the ECG findings of the pre-infarction syndrome (PIS) and evolving myocardial infarction (EMI). The ECGs of 353 STEMI patients were independently analyzed by two cardiologists, one fellow in cardiology, one fellow in internal medicine and a medical student. The last two were given a half-hour introduction of the PIS/EMI-algorithm.ResultsThe inter-observer reliability between all the investigators was found to be good according to kappa statistics (κ 0.632-0.790) for the whole study population. When divided into different subgroups, the inter-observer agreements were from good to very good between the cardiologists and the fellow in cardiology (κ 0.652 -0.813) and from moderate to good (κ 0.464-0.784) between the fellow in internal medicine, medical student and the others.ConclusionsThe PIS and EMI ECG patterns are reliably identified by experienced cardiologists and can be easily adopted by junior doctors.