Electrocardiographic diagnosis of ST segment elevation myocardial infarction: An evaluation of three automated interpretation algorithms ★★★

•This prehospital retrospective study analyzed 500 patients who had been previously enrolled in a local STEMI registry or who had been transported to one of three emergency departments with a prehospital impression of cardiac chest pain related to myocardial ischemia/infarction.•This study represents a comprehensive evaluation of computerized algorithms for a prehospital STEMI diagnosis using three computerized algorithms compared for diagnostic accuracy and clinical outcomes.•Each algorithm had differing test characteristics when assessed against the presence of a culprit artery. This demonstrates that computerized ECG algorithms vary and may be designed to optimize sensitivity or specificity.•The difference in observed sensitivity among the three algorithms, ranged 0.62–0.69 has implications for systems directing patients to bypass closer hospital and deliver them to PCI centers. While the differences in range were similar for sensitivity and specificity in identifying culprit artery, meeting a threshold of 95% specific adds to the confidence in using the diagnostic statement to help direct clinical care.

ObjectiveTo assess the validity of three different computerized electrocardiogram (ECG) interpretation algorithms in correctly identifying STEMI patients in the prehospital environment who require emergent cardiac intervention.MethodsThis retrospective study validated three diagnostic algorithms (AG) against the presence of a culprit coronary artery upon cardiac catheterization. Two patient groups were enrolled in this study: those with verified prehospital ST-elevation myocardial infarction (STEMI) activation (cases) and those with a prehospital impression of chest pain due to ACS (controls).ResultsThere were 500 records analyzed resulting in a case group with 151 patients and a control group with 349 patients. Sensitivities differed between AGs (AG1 = 0.69 vs AG2 = 0.68 vs AG3 = 0.62), with statistical differences in sensitivity found when comparing AG1 to AG3 and AG1 to AG2. Specificities also differed between AGs (AG1 = 0.89 vs AG2 = 0.91 vs AG3 = 0.95), with AG1 and AG2 significantly less specific than AG3.ConclusionsSTEMI diagnostic algorithms vary in regards to their validity in identifying patients with culprit artery lesions. This suggests that systems could apply more sensitive or specific algorithms depending on the needs in their community.