Alain Tanguay1, Johann Lebon2, Eric Brassard3, Denise Hébert4, François Bégin5. 1. Unité de Coordination Clinique des Services Préhospitaliers d'Urgence (UCCSPU), 143 Rue Wolfe, Lévis, Québec G6V 3Z1, Canada; Centre de Recherche de l'Hôtel-Dieu de Lévis, 143 Rue Wolfe, Lévis, Québec G6V 3Z1, Canada. 2. Unité de Coordination Clinique des Services Préhospitaliers d'Urgence (UCCSPU), 143 Rue Wolfe, Lévis, Québec G6V 3Z1, Canada; Centre de Recherche de l'Hôtel-Dieu de Lévis, 143 Rue Wolfe, Lévis, Québec G6V 3Z1, Canada. Electronic address: Johann.Lebon@USherbrooke.ca. 3. Faculté de Médecine Université Laval, 2325 Rue de l'Université, Québec, Québec G1V 0A6, Canada. 4. Unité de Coordination Clinique des Services Préhospitaliers d'Urgence (UCCSPU), 143 Rue Wolfe, Lévis, Québec G6V 3Z1, Canada. 5. Centre de Recherche de l'Hôtel-Dieu de Lévis, 143 Rue Wolfe, Lévis, Québec G6V 3Z1, Canada; Département de Médecine d'Urgence, Hôtel-Dieu de Lévis, 143 Rue Wolfe, Lévis, Québec G6V 3Z1, Canada.
Abstract
BACKGROUND: Prehospital 12‑lead electrocardiogram (ECG) is the most widely used screening tool for recognition of ST-segment elevation myocardial infarction (STEMI). However, prehospital diagnosis of STEMI based solely on ECGs can be challenging. OBJECTIVES: To evaluate the ability of emergency department (ED) physicians to accurately interpret prehospital 12‑lead ECGs from a remote location. METHODS: All suspected prehospital STEMI patients who were transported by EMS and underwent angiography between 2006 and 2014 were included. We reviewed prehospital ECGs and grouped them based on: 1) presence or absence of a culprit artery lesion following angiography; and 2) whether they met the 3rd Universal Definition of Myocardial Infarction. We also described characteristics of ECGs that were misinterpreted by ED physicians. RESULTS: A total of 625 suspected STEMI cases were reviewed. Following angiography, 94% (590/625) of patients were found having a culprit artery lesion, while 6% (35/625) did not. Among these 35 patients, 24 had ECGs that mimicked STEMI criteria and 9 had non-ischemic signs. Upon ECG reinterpretation, 92% (577/625) had standard STEMI criteria while 8% (48/625) did not. Among these 48 patients, 35 had ischemic signs ECGs and 13 did not. Characteristics of misinterpreted ECGs included pericarditis, early repolarization, STE > 1 mm (1‑lead only), and negative T-wave. CONCLUSIONS: Remote interpretation of prehospital 12‑lead ECGs by ED physicians was a useful diagnostic tool in this EMS system. Even if the rate of ECG misinterpretation is low, there is still room for ED physicians operating from a remote location to improve their ability to accurately diagnose STEMI patients.
BACKGROUND: Prehospital 12‑lead electrocardiogram (ECG) is the most widely used screening tool for recognition of ST-segment elevation myocardial infarction (STEMI). However, prehospital diagnosis of STEMI based solely on ECGs can be challenging. OBJECTIVES: To evaluate the ability of emergency department (ED) physicians to accurately interpret prehospital 12‑lead ECGs from a remote location. METHODS: All suspected prehospital STEMI patients who were transported by EMS and underwent angiography between 2006 and 2014 were included. We reviewed prehospital ECGs and grouped them based on: 1) presence or absence of a culprit artery lesion following angiography; and 2) whether they met the 3rd Universal Definition of Myocardial Infarction. We also described characteristics of ECGs that were misinterpreted by ED physicians. RESULTS: A total of 625 suspected STEMI cases were reviewed. Following angiography, 94% (590/625) of patients were found having a culprit artery lesion, while 6% (35/625) did not. Among these 35 patients, 24 had ECGs that mimicked STEMI criteria and 9 had non-ischemic signs. Upon ECG reinterpretation, 92% (577/625) had standard STEMI criteria while 8% (48/625) did not. Among these 48 patients, 35 had ischemic signs ECGs and 13 did not. Characteristics of misinterpreted ECGs included pericarditis, early repolarization, STE > 1 mm (1‑lead only), and negative T-wave. CONCLUSIONS: Remote interpretation of prehospital 12‑lead ECGs by ED physicians was a useful diagnostic tool in this EMS system. Even if the rate of ECG misinterpretation is low, there is still room for ED physicians operating from a remote location to improve their ability to accurately diagnose STEMI patients.
Authors: Amir Faour; Reece Pahn; Callum Cherrett; Oliver Gibbs; Karen Lintern; Christian J Mussap; Rohan Rajaratnam; Dominic Y Leung; David A Taylor; Steven C Faddy; Sidney Lo; Craig P Juergens; John K French Journal: J Am Heart Assoc Date: 2022-06-29 Impact factor: 6.106
Authors: Amir Faour; Callum Cherrett; Oliver Gibbs; Karen Lintern; Christian J Mussap; Rohan Rajaratnam; Dominic Y Leung; David A Taylor; Steve C Faddy; Sidney Lo; Craig P Juergens; John K French Journal: Catheter Cardiovasc Interv Date: 2022-06-29 Impact factor: 2.585