Evaluation of ECG algorithms designed to improve detect of transient myocardial ischemia to minimize false alarms in patients with suspected acute coronary syndrome

Pelter, Michele M.; Xu, Yuan; Fidler, Richard; Xiao, Ran; Mortara, David; Hu, Xiao

doi:10.1016/j.jelectrocard.2017.10.005

Cited by 7 publications

(4 citation statements)

References 23 publications

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“…These studies showed that transient ischemic episodes are predictive for early, as well as long-term adverse cardiac events [ 24 , 25 , 26 ]. Sensitivity of automated ST-monitoring was shown to vary dependent on the chosen threshold for significant ST-shifts [ 35 ]. However, automated continuous ST-monitoring may identify patients with transient myocardial ischemia, who would have been missed due to under-sampling or human interpretation [ 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Serial ECGs in Patients with Suspected Myocardial Infarction

Lehmacher¹,

Neumann

Sörensen

et al. 2020

JCM

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The electrocardiogram (ECG) is an important diagnostic tool for patients with suspected acute myocardial infarction (AMI). Current guidelines recommend serial ECGs in case of persisting symptoms. We aimed to analyze the predictive value of ischemic ECG-signs in patients with suspected AMI. Patients presenting to the emergency department with suspected AMI were included. All patients with ST-elevation AMI were excluded from analyses. Patients received 12-lead-ECG and high-sensitive Troponin T (hs-TnT)-measurement at admission and after 3 h. Four groups were defined: no ischemic signs in either ECG; new ischemic signs in the second ECG; resolved ischemic signs in the second ECG; and persistent ischemic signs in both ECGs. Patients were followed for 2 years to assess the composite endpoint of all-cause-mortality, AMI, and coronary revascularization. Using a 30-day landmark analysis, a Cox regression with ischemic signs as the variable of interest, adjusted by cardiovascular risk factors, was calculated. Of 1675 patients, 1321 showed no ischemic signs, in 25 new-, in 92 resolved- and in 237 patients, persistent ischemic signs were documented. Patients with persistent ischemic signs had significantly worse outcomes, compared to those without. Compared to no ischemic signs, adjusted hazard ratios for the combined endpoint were 0.81 (95% CI 0.20, 3.31; p-value = 0.77) for new-, 0.59 (95% CI 0.26, 1.34; p-value = 0.21) for resolved-, and 1.47 (95% CI 1.102, 2.13; p-value = 0.041) for persistent ischemic signs. In patients with suspected AMI, persistent ischemic ECG-signs are predictive of a higher rate of all-cause-mortality, AMI, and revascularization.

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Section: Discussionmentioning

confidence: 99%

Predictive Value of Serial ECGs in Patients with Suspected Myocardial Infarction

Lehmacher¹,

Neumann

Sörensen

et al. 2020

JCM

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“…Second, accurate classification of significant ST change at short-duration level can serve as groundwork to multiple succeeding goals. It’s been found that many false ST alarms in current in-hospital ECG monitors are induced by brief ST changes from turning, breathing, signal noise etc., and introducing a delay in monitoring algorithms can effectively reduce the number of alarms and mitigate alarm fatigue [3,20, 21]. Thus, the precise detection of short-duration ST change together with simple postprocessing steps, such as adding a delay, could provide great power in tackling the issue of excessive false positive alarms that plague the current ST monitoring software.…”

Section: Discussionmentioning

confidence: 99%

“…Another limitation of the present study is that the ST detection algorithm is built upon single-lead level, given that the database consists of ECG recordings with 2-or 3-lead configuration and annotation information is available at single-lead level. It has been found that true transient myocardial ischemia events typically have presence in contiguous leads (leads closed placed), and taking such information into account could improve detecting sensitivity [21]. Furthermore, some ischemic ST events are lead specific and can be only detectable through certain leads [22], so they might be missed by algorithms monitoring single or very few number of leads alone.…”

Section: Discussionmentioning

confidence: 99%

Monitoring significant ST changes through deep learning

Xiao

Pelter

et al. 2018

Journal of Electrocardiology

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“…More recently, Pelter et al (2016) reported that transient myocardial ischemic events predicted worsening outcomes and actually proceeded symptoms by almost 3 h, suggesting continuous ECG may be able to more accurately capture the occlusive/non-occlusive nature of NSTEMI (Pelter et al 2016). Newer computerized algorithms may be superior in identifying transient ischemia which may prompt a transition toward use in hospital settings (Pelter et al 2018. While the hypothesis of spontaneous reperfusion is feasible for the continuum of arterial occlusion (Faramand et al 2021), it is more likely to affect NSTEMI with a sub-occluded artery (TIMI flow 2-3).…”

Section: Transient Occlusionmentioning

confidence: 99%

Secondary electrocardiographic stratification of NSTEMI to identify an acutely occluded culprit artery

Dzikowicz

Carey

2023

Physiol. Meas.

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In the United States, approximately 720,000 adults will experience a myocardial infarction (MI) every year. The 12-lead electrocardiogram (ECG) is quintessential for the classification of a MI. About 30% of all MIs exhibit ST-segment elevation on the 12-lead ECG and is therefore classified as an ST-Elevation Myocardial Infarction (STEMI), which is treated emergently with percutaneous coronary intervention to restore blood flow. However, in the remaining 70% of MIs, the 12-lead ECG lacks ST-segment elevation and instead exhibits a motley of changes, including ST-segment depression, T-wave inversion, or, in up to 20% of patients, have no changes whatsoever; as such, these MIs are classified as a Non-ST Elevation Myocardial Infarction (NSTEMI). Of this large cluster of MIs, 33% of NSTEMI actually have an occlusion of the culprit artery consistent with a Type I MI per the 4th Universal Definition of MI. This is a serious clinical problem because NSTEMI with an occluded culprit artery have similar myocardial damage like STEMI and are more likely to suffer from adverse outcomes compared to NSTEMI without an occluded culprit artery. In this review article, we review the extant literature on NSTEMI with an occluded culprit artery. Afterward, we generate and discuss hypotheses for the absence of ST-segment elevation on the 12-lead ECG: (1) Transient Occlusion (2) Collateral Blood Flow and Chronically Occluded Artery and (3) ECG-Silent Myocardial Regions. Lastly, we describe and define novel ECG features that are associated with an occluded culprit artery in NSTEMI which include T-wave morphology abnormalities and novel markers of ventricular repolarization heterogeneity.

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Evaluation of ECG algorithms designed to improve detect of transient myocardial ischemia to minimize false alarms in patients with suspected acute coronary syndrome

Cited by 7 publications

References 23 publications

Predictive Value of Serial ECGs in Patients with Suspected Myocardial Infarction

Predictive Value of Serial ECGs in Patients with Suspected Myocardial Infarction

Monitoring significant ST changes through deep learning

Secondary electrocardiographic stratification of NSTEMI to identify an acutely occluded culprit artery

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