Comparative Accuracy of Manual Versus Computerized Electrocardiographic Measurement of J-, ST- and T-Wave Deviations in Patients With Acute Coronary Syndrome

Eskola, Markku; Nikus, Kjell; Voipio‐Pulkki, Liisa‐Maria; Huhtala, Heini; Parviainen, Tiina; Lund, Juha; Ilva, Tuomo; Porela, Pekka

doi:10.1016/j.amjcard.2005.07.075

Cited by 28 publications

(27 citation statements)

References 15 publications

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“…28,29 Further research is needed to elucidate the benefits and drawbacks of triage ECGs; however, they are one potential solution to gaining further reductions in door-to-ECG times, particularly for a very early target such as 4 minutes.…”

Section: Discussionmentioning

confidence: 99%

Effect of time to electrocardiogram on time from electrocardiogram to fibrinolysis in acute myocardial infarction patients

Atzema

Austin²,

Tu³

et al. 2011

CJEM

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Objective: The American Heart Association (AHA) recommends a benchmark door-to-electrocardiogram (ECG) time of 10 minutes for acute myocardial infarction patients, but this is based on expert opinion (level of evidence C). We sought to establish an evidence-based benchmark door-to-ECG time.Methods: This retrospective cohort study used a populationbased sample of patients who suffered an ST elevation myocardial infarction (STEMI) in Ontario between 1999 and 2001. Using cubic smoothing splines, we described (1) the relationship between door-to-ECG time and ECG-to-needle time and (2) the proportion of STEMI patients who met the benchmark door-to-needle time of 30 minutes based on their door-to-ECG time. We hypothesized nonlinear relationships and sought to identify an inflection point in the latter curve that would define the most efficient (benefit the greatest number of patients) door-to-ECG time. Results: In 2,961 STEMI patients, the median door-to-ECG and ECG-to-needle times were 8.0 and 27.0 minutes, respectively. There was a linear increase in ECG-to-needle time as the door-to-ECG time increased, up to approximately 30 minutes, after which the ECG-to-needle time remained constant at 53 minutes. The inflection point in the probability of achieving the benchmark door-to-needle time occurred at 4 minutes, after which it decreased linearly, with every minute of door-to-ECG time decreasing the average probability of achievement by 2.2%. Conclusions: Hospitals that are not meeting benchmark reperfusion times may improve performance by decreasing door-to-ECG times, even if they are meeting the current AHA benchmark door-to-ECG time. The highest probability of meeting the reperfusion target time for fibrinolytic administration is associated with a door-to-ECG time of 4 minutes or less.

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Section: Discussionmentioning

confidence: 99%

Effect of time to electrocardiogram on time from electrocardiogram to fibrinolysis in acute myocardial infarction patients

Atzema

Austin²,

Tu³

et al. 2011

CJEM

View full text Add to dashboard Cite

show abstract

“…Yet such diagnostic ECG computer programs have not been shown to be equal or superior to the specialist physician's judgment 18. Moreover, studies comparing computerized with manual ECG measurements in patients with acute coronary syndrome have shown that computerized measurements have diagnostic cut-offs that differ from manual measurements and may not be used interchangeably 19. This is likely one reason underlying the limited acceptance of such techniques in clinical practice during the follow-up period after coronary revascularization.…”

Section: Introductionmentioning

confidence: 99%

Computerized two-lead resting ECG analysis for the detection of coronary artery stenosis after coronary revascularization

Grube¹,

Bootsveld²,

Buellesfeld³

et al. 2008

Int. J. Med. Sci.

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Background: Resting electrocardiogram (ECG) shows limited sensitivity and specificity for the detection of coronary artery disease (CAD), where patients with a history of coronary revascularization may pose special challenges. Several methods exist to enhance sensitivity and specificity of resting ECG for diagnosis of CAD, but such methods are not better than a specialist's judgement. We compared a new computer-enhanced, resting ECG analysis device, 3DMP, to coronary angiography to evaluate the device's accuracy in detecting hemodynamically relevant CAD.Methods: A convenience sample of 172 patients with a history of coronary revascularization scheduled for coronary angiography was evaluated with 3DMP before coronary angiography. 3DMP's sensitivity and specificity in detecting hemodynamically relevant coronary stenosis as diagnosed with coronary angiography were calculated as well as odds ratios for the 3DMP severity score and coronary artery disease risk factors.Results: The 3DMP system accurately identified 50 of 55 patients as having hemodynamically relevant stenosis (sensitivity 90.9%, specificity 88.0%). Positive and negative predictive values for the identification of coronary stenosis as diagnosed in coronary angiograms were 62.7% and 97.8% respectively. Risk and demographic factors in a logistic regression model had a markedly lower predictive power for the presence of coronary stenosis in these patients than did 3DMP severity score (odds ratio 2.04 [0.74-5.62] vs. 73.57 [25.10-215.68]). A logistic regression combining severity score with risk and demographic factors did not add significantly to the prediction quality (odds ratio 80.00 [27.03-236.79]).Conclusions: 3DMP's computer-based, mathematically derived analysis of resting two-lead ECG data provides detection of hemodynamically relevant CAD in patients with a history of coronary revascularization with high sensitivity and specificity that appears to be at least as good as those reported for other resting and/or stress ECG methods currently used in clinical practice.

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“…However, diagnostic ECG computer programs have not yet been shown to be equal or superior to the specialist physician's judgment 15. Moreover, studies comparing computerized with manual ECG measurements in patients with an acute coronary syndrome have shown that computerized measurements have diagnostic cut-offs that differ from manual measurements and therefore may not be used interchangeably 16. This is one of the likely reasons underlying the limited acceptance of such techniques in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Computerized two-lead resting ECG analysis for the detection of coronary artery stenosis

Grube

Bootsveld²,

Yuecel³

et al. 2007

Int. J. Med. Sci.

View full text Add to dashboard Cite

Background:Resting electrocardiogram (ECG) shows limited sensitivity and specificity for the detection of coronary artery disease (CAD). Several methods exist to enhance sensitivity and specificity of resting ECG for diagnosis of CAD, but such methods are not better than a specialist's judgement. We compared a new computer-enhanced, resting ECG analysis device, 3DMP, to coronary angiography to evaluate the device's accuracy in detecting hemodynamically relevant CAD. Methods: A convenience sample of 423 patients without prior coronary revascularization was evaluated with 3DMP before coronary angiography. 3DMP's sensitivity and specificity in detecting hemodynamically relevant coronary stenosis as diagnosed with coronary angiography were calculated as well as odds ratios for the 3DMP severity score and coronary artery disease risk factors. Results: 3DMP identified 179 of 201 patients with hemodynamically relevant stenosis (sensitivity 89.1%, specificity 81.1%). The positive and negative predictive values for identification of coronary stenosis as diagnosed in coronary angiograms were 79% and 90% respectively. CAD risk factors in a logistic regression model had markedly lower predictive power for the presence of coronary stenosis in patients than did 3DMP severity score (odds ratio 3.35 [2.24-5.01] vs. 34.87 [20.00-60.79]). Logistic regression combining severity score with risk factors did not add significantly to the prediction quality (odds ratio 36.73 [20.92-64.51 ]).Conclusions: 3DMP's computer-based, mathematically derived analysis of resting two-lead ECG data provides detection of hemodynamically relevant CAD with high sensitivity and specificity that appears to be at least as good as those reported for other resting and/or stress ECG methods currently used in clinical practice.

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Comparative Accuracy of Manual Versus Computerized Electrocardiographic Measurement of J-, ST- and T-Wave Deviations in Patients With Acute Coronary Syndrome

Cited by 28 publications

References 15 publications

Effect of time to electrocardiogram on time from electrocardiogram to fibrinolysis in acute myocardial infarction patients

Effect of time to electrocardiogram on time from electrocardiogram to fibrinolysis in acute myocardial infarction patients

Computerized two-lead resting ECG analysis for the detection of coronary artery stenosis after coronary revascularization

Computerized two-lead resting ECG analysis for the detection of coronary artery stenosis

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