The impact of numeric and graphic displays of ST-segment deviation levels on cardiologists' decisions of reperfusion therapy for patients with acute coronary occlusion

• Published in: Journal of electrocardiology Vol. 44; no. 5; pp. 502 - 508
• Main Authors: Nimmermark, Magnus O., MD, Wang, John J., MS, Maynard, Charles, PhD, Cohen, Mauricio, MD, Gilcrist, Ian, MD, Heitner, John, MD, Hudson, Michael, MD, Palmeri, Sebastian, MD, Wagner, Galen S., MD, Pahlm, Olle, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2011
• Subjects: Angioplasty, Balloon, Coronary; Cardiac and Cardiovascular Systems; Cardiovascular; Case-Control Studies; Clinical Medicine; Data Display; Decision Making; Electrocardiogram; Electrocardiography; Female; Humans; Kardiologi; Klinisk medicin; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Myocardial infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - therapy; Myocardial Reperfusion - methods; Reperfusion; Sensitivity and Specificity; ST-segments; Myocardial infarction; ST-segments; Reperfusion; Electrocardiogram
• ISSN: 0022-0736; 1532-8430; 1532-8430
• DOI: 10.1016/j.jelectrocard.2011.06.009

Abstract The study purpose is to determine whether numeric and/or graphic ST measurements added to the display of the 12-lead electrocardiogram (ECG) would influence cardiologists' decision to provide myocardial reperfusion therapy. Twenty ECGs with borderline ST-segment deviation during elective percutaneous coronary intervention and 10 controls before balloon inflation were included. Only 5 of the 20 ECGs during coronary balloon occlusion met the 2007 American Heart Association guidelines for ST-elevation myocardial infarction (STEMI). Fifteen cardiologists read 4 sets of these ECGs as the basis for a “yes/no” reperfusion therapy decision. Sets 1 and 4 were the same 12-lead ECGs alone. Set 2 also included numeric ST-segment measurements, and set 3 included both numeric and graphically displayed ST measurements (“ST Maps”). The mean (range) positive reperfusion decisions were 10.6 (2-15), 11.4 (1-19), 9.7 (2-14), and 10.7 (1-15) for sets 1 to 4, respectively. The accuracies of the observers for the 5 STEMI ECGs were 67%, 69%, and 77% for the standard format, the ST numeric format, and the ST graphic format, respectively. The improved detection rate (77% vs 67%) with addition of both numeric and graphic displays did achieve statistical significance ( P < .025). The corresponding specificities for the 10 control ECGs were 85%, 79%, and 89%, respectively. In conclusion, a wide variation of reperfusion decisions was observed among clinical cardiologists, and their decisions were not altered by adding ST deviation measurements in numeric and/or graphic displays. Acute coronary occlusion detection rate was low for ECGs meeting STEMI criteria, and this was improved by adding ST-segment measurements in numeric and graphic forms. These results merit further study of the clinical value of this technique for improved acute coronary occlusion treatment decision support.