Salah S Al-Zaiti1, Christian Martin-Gill2, Ervin Sejdić3, Mohammad Alrawashdeh4, Clifton Callaway2. 1. Department of Acute and Tertiary Care Nursing at the University of Pittsburgh, Pittsburgh PA. Electronic address: ssa33@pitt.edu. 2. Department of Emergency Medicine at the University of Pittsburgh, Pittsburgh PA. 3. Department of Electrical and Computer Engineering at the University of Pittsburgh, Pittsburgh PA. 4. Department of Acute and Tertiary Care Nursing at the University of Pittsburgh, Pittsburgh PA.
Abstract
BACKGROUND: The serum rise of cardiac troponin remains the gold standard for diagnosing non-ST elevation (NSTE) myocardial infarction (MI) despite its delayed response. Novel methods for real-time detection of NSTEMI would result in more immediate initiation of definitive medical therapy and faster transport to facilities that can provide specialized cardiac care. METHODS: EMPIRE is an ongoing prospective, observational cohort study designed to quantify the magnitude of ischemia-induced repolarization dispersion for the early detection of NSTEMI. In this ongoing study, prehospital ECG data is gathered from patients who call 9-1-1 with a chief complaint of non-traumatic chest pain. This data is then analyzed using the principal component analysis (PCA) technique of 12-lead ECGs to fully characterize the spatial and temporal qualities of STT waveforms. RESULTS: Between May and December of 2013, Pittsburgh EMS obtained and transmitted 351 prehospital ECGs of the 1149 patients with chest pain-related emergency dispatches transported to participating hospitals. After excluding those with poor ECG signal (n=40, 11%) and those with pacing or LBBB (n=50, 14%), there were 261 eligible patients (age 57±16years, 45% female, 45% Black). In this preliminary sample, there were 19 STEMI (7%) and 33 NSTEMI (12%). More than 50% of those with infarction (STEMI or NSTEMI) had initially negative troponin values upon presentation. We present ECG data of such NSTEMI case that was identified correctly using our methods. CONCLUSIONS: Concrete ECG algorithms that can quantify NSTE ischemia and allow differential treatment based on such ECG changes could have an immediate clinical impact on patient outcomes. We describe the rationale, development, design, and potential usefulness of the EMPIRE study. The findings may provide insights that can influence guidelines revisions and improve public health.
BACKGROUND: The serum rise of cardiac troponin remains the gold standard for diagnosing non-ST elevation (NSTE) myocardial infarction (MI) despite its delayed response. Novel methods for real-time detection of NSTEMI would result in more immediate initiation of definitive medical therapy and faster transport to facilities that can provide specialized cardiac care. METHODS: EMPIRE is an ongoing prospective, observational cohort study designed to quantify the magnitude of ischemia-induced repolarization dispersion for the early detection of NSTEMI. In this ongoing study, prehospital ECG data is gathered from patients who call 9-1-1 with a chief complaint of non-traumatic chest pain. This data is then analyzed using the principal component analysis (PCA) technique of 12-lead ECGs to fully characterize the spatial and temporal qualities of STT waveforms. RESULTS: Between May and December of 2013, Pittsburgh EMS obtained and transmitted 351 prehospital ECGs of the 1149 patients with chest pain-related emergency dispatches transported to participating hospitals. After excluding those with poor ECG signal (n=40, 11%) and those with pacing or LBBB (n=50, 14%), there were 261 eligible patients (age 57±16years, 45% female, 45% Black). In this preliminary sample, there were 19 STEMI (7%) and 33 NSTEMI (12%). More than 50% of those with infarction (STEMI or NSTEMI) had initially negative troponin values upon presentation. We present ECG data of such NSTEMI case that was identified correctly using our methods. CONCLUSIONS: Concrete ECG algorithms that can quantify NSTE ischemia and allow differential treatment based on such ECG changes could have an immediate clinical impact on patient outcomes. We describe the rationale, development, design, and potential usefulness of the EMPIRE study. The findings may provide insights that can influence guidelines revisions and improve public health.
Authors: Ziad Faramand; Stephanie O Frisch; Christian Martin-Gill; Parker Landis; Mohammad Alrawashdeh; Khaled A Al-Robaidi; Clifton W Callaway; Salah S Al-Zaiti Journal: Emerg Med J Date: 2019-07-31 Impact factor: 2.740
Authors: Salah Al-Zaiti; Ervin Sejdić; Jan Nemec; Clifton Callaway; Prem Soman; Robert Lux Journal: Med Biol Eng Comput Date: 2017-06-19 Impact factor: 2.602
Authors: Stephanie O Frisch; Julissa Brown; Ziad Faramand; Jennifer Stemler; Ervin Sejdić; Christian Martin-Gill; Clifton Callaway; Susan M Sereika; Salah S Al-Zaiti Journal: Res Nurs Health Date: 2020-06-03 Impact factor: 2.228
Authors: Salah S Al-Zaiti; Mohammad Alrawashdeh; Christian Martin-Gill; Clifton Callaway; David Mortara; Jan Nemec Journal: J Electrocardiol Date: 2017-08-10 Impact factor: 1.438
Authors: Ivo Strebel; Raphael Twerenbold; Jasper Boeddinghaus; Roger Abächerli; Maria Rubini Giménez; Karin Wildi; Karin Grimm; Christian Puelacher; Patrick Badertscher; Zaid Sabti; Dominik Breitenbücher; Janina Jann; Farah Selman; Jeanne du Fay de Lavallaz; Nicolas Schaerli; Thomas Nestelberger; Claudia Stelzig; Michael Freese; Lukas Schumacher; Stefan Osswald; Christian Mueller; Tobias Reichlin Journal: Ann Noninvasive Electrocardiol Date: 2018-02-24 Impact factor: 1.468
Authors: Salah S Al-Zaiti; Ziad Faramand; Mohammad O Alrawashdeh; Susan M Sereika; Christian Martin-Gill; Clifton Callaway Journal: Am J Emerg Med Date: 2018-06-08 Impact factor: 2.469