Effect of Real-Time Physician Oversight of Prehospital STEMI Diagnosis on ECG-Inappropriate and False Positive Catheterization Laboratory Activation

Abstract

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

“…[35][36][37][38][39] The incremental benefit of PH-ECG transmission on the diagnostic accuracy and appropriateness of CCL activation has been examined in a small number of studies with conflicting results. 13,17,18 Davis et al 17 compared paramedic-based CCL activation versus transmission to emergency physicians for interpretation and demonstrated improved positive predictive value for identifying STEMI during the transmission phase of their trial (96% vs. 78%, p < 0.01).…”

“…11,13,14,33 Our study is the largest to examine the appropriateness of CCL activation utilizing PH-ECG transmission to interventional cardiologists. In previous studies, the PH-ECG was transmitted to emergency physicians, [17][18][19][20] and in two studies, cardiologists were part of the ECG reading team 34 or consulted in unclear cases. 13 Initial studies on PH-ECG transmission conducted more than a decade ago primarily examined the effect of PH-ECG transmission on reperfusion times, and compared transmission to cardiologists with historical controls, self-presenting patients, or failed transmissions.…”

“…Our study is the largest to examine the appropriateness of CCL activation utilizing PH‐ECG transmission to interventional cardiologists. In previous studies, the PH‐ECG was transmitted to emergency physicians, 17–20 and in two studies, cardiologists were part of the ECG reading team 34 or consulted in unclear cases 13 …”

“…However, 28% of PH‐ECGs were transmitted successfully and transmission had no effect on total ischemic time. More recently, Boivin‐Proulx et al 18 examined the appropriateness of 428 PH‐ECG‐based CCL activations and reported a trend toward a reduction in the number of inappropriate CCL activations with transmission to emergency physicians for over‐read compared with PH‐ECG computer interpretation (7% vs. 3%, p = 0.062). However, PH‐ECG transmission was associated with longer reperfusion times (median FMC‐to‐device time, 86 vs. 76 min, p < 0.001).…”

“…3,4 The small of number studies comparing the accuracy of PH-ECG computer interpretation (with or without paramedic over-read) with transmission for clinician interpretation have reported conflicting results. 13,17,18 In addition, these studies, 13,17,18 and others 19,20 reporting on the accuracy of PH-ECG transmission primarily involved transmission to emergency physicians for over-read. As examination of the appropriateness of CCL activation using PH-ECG transmission with interventional cardiologist over-read has not been assessed, we evaluated this strategy.…”