Acute Ischemic Heart DiseaseStrict reliance on a computer algorithm or measurable ST segment criteria may lead to errors in thrombolytic therapy eligibility☆,☆☆
Section snippets
Methods
Seventy-five ECGs were independently interpreted by 3 cardiologists on 2 occasions (within 7 days) to study ECG interpretation in the setting of AMI. The ECGs were selected among patients in our cardiac care unit or ward and were roughly evenly divided among (1) normal, (2) those showing evidence of acute transmural injury, or (3) those showing other ST-segment or T-wave abnormalities. The latter included ischemic ST-segment depression and/or T-wave inversion and mimics of acute transmural
Observer variability
Raw agreement between raters regarding the presence of ≥1 mm ST elevation (measured criteria) or thrombolysis-eligible AMI based on interpretive criteria was excellent (Table I).Agreement corrected for chance (κ) was good to excellent and tended to be better for interpretive compared with measured criteria (κ = 0.89 vs 0.78, respectively; P =.13).
Intraobserver variability was substantial for each reader (κ = 0.67, 0.69, and 0.71) but lower than the interobserver variability for each criteria (
Discussion
At present, a carefully performed patient history and clinical examination coupled with an accurate ECG interpretation are still the best method of diagnosing a thrombolysis-eligible AMI candidate. Our study demonstrates that human estimation of quantifiable parameters alone, such as the amount of ST-segment elevation, are insufficient for deciding thrombolytic therapy eligibility because there are many ECG mimics of AMI. Our results are in keeping with those of Otto and Aufderheide,14 who
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Dr Dawdy was supported by the Victoria Hospital Research and Development Fund.
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Reprint requests: David Massel, MD, FRCPC, Medical Director, Cardiac Care Unit, London Health Sciences Centre, Room 205, Colborne Building, Victoria Campus, 375 South St, London, Ontario, Canada N6A 4G5. E-mail: [email protected]