Detection of STEMI Using Prehospital Serial 12-Lead Electrocardiograms

Tanguay, Alain; J, Lebon; Lau, Lorraine; Hébert, Denise; Bégin, François

doi:10.1080/10903127.2017.1399185

Cited by 11 publications

(13 citation statements)

References 28 publications

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“…Especially, clinically unstable and agitated patients may have impaired diagnostic performance of the acquired ECGs. Secondly and likely more importantly, electrocardiographic findings in ACS patients may show dynamic alterations over time and in some cases the exact timing of ECG acquisition may be of critical importance, especially in light of other prehospital therapeutic interventions such as aspirin, heparin and morphine (8,(28)(29)(30).…”

Section: Discussionmentioning

confidence: 99%

“…As the institutional review board had required that trial conduction was not to impair or protract diagnostic or therapeutic algorithms, treating EPs and their teams probably waived repeated/parallel ECG acquisition of c12L-ECGs in case these had already been acquired. However, due to dynamic alterations in ACS patients over time, the exact timing of ECG acquisition may be of critical importance (8,(28)(29)(30). Future comparative studies will have to ensure correct electrode placement, synchrony and longitudinal diagnostic non-inferiority in this regard.…”

Section: Study Limitationsmentioning

confidence: 99%

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Feasibility of CardioSecur®, a Mobile 4-Electrode/22-Lead ECG Device, in the Prehospital Emergency Setting

Spaich

Kern

Zelniker

et al. 2020

Front. Cardiovasc. Med.

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Background: This study explores the application of CardioSecur ® (CS-ECG), a hand-held 4-electrode/22-lead ECG-device, in comparison with conventional 12-lead electrocardiogram (c12L-ECG) in patients with acute chest pain in the prehospital emergency setting. Methods: CS-ECG systems were provided for two physician-staffed emergency ambulances and parallel recordings of c12L-ECG and CS-ECG were obtained from all patients with acute chest pain. Treating emergency physicians were asked to evaluate the CS-ECG system with a standardized questionnaire. Following study completion, acquired ECGs were analyzed separately by two independent cardiologists blinded to all other medical records. Results: Over a period of 20 months a total of 203 patients were included in our study. According to a standardized questionnaire, 79% of emergency medical professionals preferred application of CS-ECG, with 87% of teams judging CS-ECG to be beneficial for patients. Morover, 79% of physicians reported a reduction in time to definitive diagnosis with implementation of CS-ECG. The majority of professional users attested user-friendliness and feasibility of CS-ECG in terms of easy general handling (94%), application (93%), and placement of electrodes (98%). During prehospital triage, both c12L-ECG and CS-ECG correctly identified 31 (91%) patients with ST-elevation myocardial infarction (STEMI). Conclusion: In this first pilot study, implementation of the CardioSecur ®-ECG system in the prehospital emergency setting demonstrated feasibility and user-friendliness so that emergency teams generally preferred CS-ECG to c12L-ECG. Diagnostic yield of CS-ECG was similar to c12L-ECG recordings.

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Section: Discussionmentioning

confidence: 99%

Section: Study Limitationsmentioning

confidence: 99%

Feasibility of CardioSecur®, a Mobile 4-Electrode/22-Lead ECG Device, in the Prehospital Emergency Setting

Spaich

Kern

Zelniker

et al. 2020

Front. Cardiovasc. Med.

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“…Repeating the ECG may also have a role, as previous literature has shown that repeat prehospital ECGs increase the identification of STEMI. 30,31 It is unclear if this effect is from the evolution of the infarct or acquiring a higher quality ECG. When utilizing the ED ECG for these cases, the algorithm accurately classified all cases.…”

Section: Discussionmentioning

confidence: 99%

A Novel Algorithm for Improving the Diagnostic Accuracy of Prehospital ST-Elevation Myocardial Infarction

Goebel

Vaida

Kahn

et al. 2019

Prehosp. Disaster med.

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Introduction:ST-segment elevation myocardial infarction (STEMI) is a time-sensitive entity that has been shown to benefit from prehospital diagnosis by electrocardiogram (ECG). Current computer algorithms with binary decision making are not accurate enough to be relied on for cardiac catheterization lab (CCL) activation.Hypothesis:An algorithmic approach is proposed to stratify binary STEMI computerized ECG interpretations into low, intermediate, and high STEMI probability tiers.Methods:Based on previous literature, a four-criteria algorithm was developed to rule out/in common causes of prehospital STEMI false-positive computer interpretations: heart rate, QRS width, ST elevation criteria, and artifact. Prehospital STEMI cases were prospectively collected at a single academic center in Salt Lake City, Utah (USA) from May 2012 through October 2013. The prehospital ECGs were applied to the algorithm and compared against activation of the CCL by an emergency department (ED) physician as the outcome of interest. In addition to calculating test characteristics, linear regression was used to look for an association between number of criteria used and accuracy, and logistic regression was used to test if any single criterion performed better than another.Results:There were 63 ECGs available for review, 39 high probability and 24 intermediate probability. The high probability STEMI tier had excellent test characteristics for ruling in STEMI when all four criteria were used, specificity 1.00 (95% CI, 0.59-1.00), positive predictive value 1.00 (0.91-1.00). Linear regression showed a strong correlation demonstrating that false-positives increased as fewer criteria were used (adjusted r-square 0.51; P <.01). Logistic regression showed no significant predictive value for any one criterion over another (P = .80). Limiting physician overread to the intermediate tier only would reduce the number of ECGs requiring physician overread by a factor of 0.62 (95% CI, 0.48-0.75; P <.01).Conclusion:Prehospital STEMI ECGs can be accurately stratified to high, intermediate, and low probabilities for STEMI using the four criteria. While additional study is required, using this tiered algorithmic approach in prehospital ECGs could lead to changes in CCL activation and decreased requirements for physician overread. This may have significant clinical and quality implications.

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“…41 Ischemic Heart Disease Interventions Accurate and efficient interpretation of pre-hospital 12-lead electrocardiograms (ECGs) has shown to produce favourable patient outcomes as it reduces the delay to reperfusion through fibrinolysis or percutaneous coronary intervention (PCI) therapies. 42 Tanguay and colleagues reported on a virtual care-based STEMI detection program used throughout rural Quebec. This 7year retrospective study included 728 patients with suspected STEMI who were transported by EMS.…”

Section: Cardiac Arrhythmia Interventionsmentioning

confidence: 99%

“…Thus, serial monitoring of these dynamic changes can allow for more rapid diversion to primary PCI facilities, potentially improving outcomes. 42 Such an approach could also lend itself well to machine learning decision support systems that improve triage or follow-up. The American Heart Association guidelines recommend that the time between first medical contact and balloon inflation for STEMI patients should not exceed 90 minutes.…”

Section: Cardiac Arrhythmia Interventionsmentioning

confidence: 99%

Virtual care with digital technologies for rural and remote Canadians living with cardiovascular disease

Buyting

Melville

Chatur

et al. 2020

Preprint

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Canada is a wealthy nation with a geographically diverse population, seeking health innovations to better serve patients in accordance with the Canada Health Act. In this country, population and geography converge with social determinants, policy, procurement regulations, and technological advances, in order to achieve equity in the management and distribution of healthcare. Rural and remote patients are a vulnerable population; when managing chronic conditions such as cardiovascular disease, there is inequity when it comes to accessing specialist physicians at the recommended frequency—increasing the likelihood of poor health outcomes. Ensuring equitable care for this population is an unrealized priority of several provincial and federal government mandates. Virtual care technology may provide practical, economical, and innovative solutions to remedy this discrepancy. Here we review the literature pertaining to the use of virtual care technologies to monitor patients with cardiovascular disease living in rural areas of Canada. A search strategy was developed to identify the literature specific to this context across three bibliographic databases. 166 unique citations were ultimately assessed for eligibility, of which 36 met the inclusion criteria. In our assessment of these articles, we provide a summary of the interventions studied, their reported effectiveness in reducing adverse events and mortality, the challenges to implementation, and the receptivity of these technologies amongst patients, providers and policy makers. Further, we glean insight into the barriers and opportunities to ensure equitable care for rural patients and conclude that there is an ongoing need for clinical trials assessing virtual care technologies in this context.SummaryPatients living in rural and remote communities’ experience diverse challenges to receiving equitable healthcare as is mandated by the Canada Health Act. Advances in virtual care technology may provide practical, economical, and innovative solutions to ensure this for patients in remote and rural living situations. Here we provide a state-of-the-art review of virtual care technologies available to patients with cardiovascular disease living in rural areas of Canada.

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Detection of STEMI Using Prehospital Serial 12-Lead Electrocardiograms

Cited by 11 publications

References 28 publications

Feasibility of CardioSecur®, a Mobile 4-Electrode/22-Lead ECG Device, in the Prehospital Emergency Setting

Feasibility of CardioSecur®, a Mobile 4-Electrode/22-Lead ECG Device, in the Prehospital Emergency Setting

A Novel Algorithm for Improving the Diagnostic Accuracy of Prehospital ST-Elevation Myocardial Infarction

Virtual care with digital technologies for rural and remote Canadians living with cardiovascular disease

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