Utility of prehospital electrocardiogram interpretation in ST-segment elevation myocardial infarction utilizing computer interpretation and transmission for interventional cardiologist consultation

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

doi:10.1002/ccd.30300

Utility of prehospital electrocardiogram interpretation in ST-segment elevation myocardial infarction utilizing computer interpretation and transmission for interventional cardiologist consultation

Catheter Cardiovasc Interv. 2022 Sep;100(3):295-303. doi: 10.1002/ccd.30300. Epub 2022 Jun 29.

Authors

Amir Faour^{1

2}, Callum Cherrett¹, Oliver Gibbs¹, Karen Lintern¹, Christian J Mussap^{1

2

3}, Rohan Rajaratnam^{1

2

3}, Dominic Y Leung^{1

2

3}, David A Taylor¹, Steve C Faddy⁴, Sidney Lo^{1

2

3}, Craig P Juergens^{1

2}, John K French^{1

2

3

5}

Affiliations

¹ Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia.
² South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
³ School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
⁴ New South Wales Ambulance, Sydney, New South Wales, Australia.
⁵ Ingham Institute, Sydney, New South Wales, Australia.

Abstract

Objectives: We examined the appropriateness of prehospital cardiac catheter laboratory activation (CCL-A) in ST-segment elevation myocardial infarction (STEMI) utilizing the University of Glasgow algorithm (UGA) and remote interventional cardiologist consultation.

Background: The incremental benefit of prehospital electrocardiogram (PH-ECG) transmission on the diagnostic accuracy and appropriateness of CCL-A has been examined in a small number of studies with conflicting results.

Methods: We identified consecutive PH-ECG transmissions between June 2, 2010 and October 6, 2016. Blinded adjudication of ECGs, appropriateness of CCL-A, and index diagnoses were performed using the fourth universal definition of MI. The primary outcome was the appropriate CCL-A rate. Secondary outcomes included rates of false-positive CCL-A, inappropriate CCL-A, and inappropriate CCL nonactivation.

Results: Among 1088 PH-ECG transmissions, there were 565 (52%) CCL-As and 523 (48%) CCL nonactivations. The appropriate CCL-A rate was 97% (550 of 565 CCL-As), of which 4.9% (n = 27) were false-positive. The inappropriate CCL-A rate was 2.7% (15 of 565 CCL-As) and the inappropriate CCL nonactivation rate was 3.6% (19 of 523 CCL nonactivations). Reasons for appropriate CCL nonactivation (n = 504) included nondiagnostic ST-segment elevation (n = 128, 25%), bundle branch block (n = 132, 26%), repolarization abnormality (n = 61, 12%), artefact (n = 72, 14%), no ischemic symptoms (n = 32, 6.3%), severe comorbidities (n = 26, 5.2%), transient ST-segment elevation (n = 20, 4.0%), and others.

Conclusions: PH-ECG interpretation utilizing UGA with interventional cardiologist consultation accurately identified STEMI with low rates of inappropriate and false-positive CCL-As, whereas using UGA alone would have almost doubled CCL-As. The benefits of cardiologist consultation were identifying "masquerading" STEMI and avoiding unnecessary CCL-As.

Keywords: ST-segment elevation myocardial; acute coronary syndrome; cardiac catheterization laboratory; infarction; interventional cardiology; myocardial infarction; percutaneous coronary intervention; prehospital ECG interpretation.

MeSH terms

Bundle-Branch Block
Cardiologists*
Computers
Electrocardiography
Emergency Medical Services* / methods
Humans
Referral and Consultation
Retrospective Studies
ST Elevation Myocardial Infarction* / diagnosis
ST Elevation Myocardial Infarction* / therapy
Treatment Outcome