Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Low diagnostic yield of ST elevation myocardial infarction amplitude criteria in chest pain patients at the emergency department

Lindow, Thomas ; Engblom, Henrik LU ; Pahlm, Olle LU ; Carlsson, Marcus LU ; Lassen, Annmarie Touborg ; Brabrand, Mikkel ; Lundager Forberg, Jakob LU ; Platonov, Pyotr G LU and Ekelund, Ulf LU orcid (2021) In Scandinavian Cardiovascular Journal p.1-8
Abstract
To evaluate the diagnostic yield of the ECG criteria for ST-elevation myocardial infarction in a large cohort of emergency department chest pain patients, and to determine whether extended ECG criteria or reciprocal ST depression can improve accuracy. Design: Observational, register-based diagnostic study on the accuracy of ECG criteria for ST-elevation myocardial infarction. Between Jan 2010 and Dec 2014 all patients aged ≥30 years with chest pain who had an ECG recorded within 4 h at two emergency departments in Sweden were included. Exclusion criteria were: ECG with poor technical quality; QRS duration ≥120 ms; ECG signs of left ventricular hypertrophy; or previous coronary artery bypass surgery. Conventional and extended ECG criteria... (More)
To evaluate the diagnostic yield of the ECG criteria for ST-elevation myocardial infarction in a large cohort of emergency department chest pain patients, and to determine whether extended ECG criteria or reciprocal ST depression can improve accuracy. Design: Observational, register-based diagnostic study on the accuracy of ECG criteria for ST-elevation myocardial infarction. Between Jan 2010 and Dec 2014 all patients aged ≥30 years with chest pain who had an ECG recorded within 4 h at two emergency departments in Sweden were included. Exclusion criteria were: ECG with poor technical quality; QRS duration ≥120 ms; ECG signs of left ventricular hypertrophy; or previous coronary artery bypass surgery. Conventional and extended ECG criteria were applied to all patients. The main outcome was acute myocardial infarction (AMI) and an occluded/near-occluded coronary artery at angiography. Results: Finally, 19932 patients were included. Conventional ECG criteria for ST elevation myocardial infarction were fulfilled in 502 patients, and extended criteria in 1249 patients. Sensitivity for conventional ECG criteria in diagnosing AMI with coronary occlusion/near-occlusion was 17%, specificity 98% and positive predictive value 12%. Corresponding data for extended ECG criteria were 30%, 94% and 8%. When reciprocal ST depression was added to the criteria, the positive predictive value rose to 24% for the conventional and 23% for the extended criteria. Conclusions: In unselected chest pain patients at the emergency department, the diagnostic yield of both conventional and extended ECG criteria for ST-elevation myocardial infarction is low. The PPV can be increased by also considering reciprocal ST depression. (Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Scandinavian Cardiovascular Journal
pages
1 - 8
publisher
Taylor & Francis
external identifiers
  • pmid:33461362
  • scopus:85099530246
ISSN
1651-2006
DOI
10.1080/14017431.2021.1875138
project
AIR Lund - Artificially Intelligent use of Registers
language
English
LU publication?
yes
id
8ee1a4a0-a7e4-4d87-85d9-d8b1fae3976a
date added to LUP
2021-03-29 15:33:14
date last changed
2024-02-20 01:41:22
@article{8ee1a4a0-a7e4-4d87-85d9-d8b1fae3976a,
  abstract     = {{To evaluate the diagnostic yield of the ECG criteria for ST-elevation myocardial infarction in a large cohort of emergency department chest pain patients, and to determine whether extended ECG criteria or reciprocal ST depression can improve accuracy. Design: Observational, register-based diagnostic study on the accuracy of ECG criteria for ST-elevation myocardial infarction. Between Jan 2010 and Dec 2014 all patients aged ≥30 years with chest pain who had an ECG recorded within 4 h at two emergency departments in Sweden were included. Exclusion criteria were: ECG with poor technical quality; QRS duration ≥120 ms; ECG signs of left ventricular hypertrophy; or previous coronary artery bypass surgery. Conventional and extended ECG criteria were applied to all patients. The main outcome was acute myocardial infarction (AMI) and an occluded/near-occluded coronary artery at angiography. Results: Finally, 19932 patients were included. Conventional ECG criteria for ST elevation myocardial infarction were fulfilled in 502 patients, and extended criteria in 1249 patients. Sensitivity for conventional ECG criteria in diagnosing AMI with coronary occlusion/near-occlusion was 17%, specificity 98% and positive predictive value 12%. Corresponding data for extended ECG criteria were 30%, 94% and 8%. When reciprocal ST depression was added to the criteria, the positive predictive value rose to 24% for the conventional and 23% for the extended criteria. Conclusions: In unselected chest pain patients at the emergency department, the diagnostic yield of both conventional and extended ECG criteria for ST-elevation myocardial infarction is low. The PPV can be increased by also considering reciprocal ST depression.}},
  author       = {{Lindow, Thomas and Engblom, Henrik and Pahlm, Olle and Carlsson, Marcus and Lassen, Annmarie Touborg and Brabrand, Mikkel and Lundager Forberg, Jakob and Platonov, Pyotr G and Ekelund, Ulf}},
  issn         = {{1651-2006}},
  language     = {{eng}},
  pages        = {{1--8}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Cardiovascular Journal}},
  title        = {{Low diagnostic yield of ST elevation myocardial infarction amplitude criteria in chest pain patients at the emergency department}},
  url          = {{http://dx.doi.org/10.1080/14017431.2021.1875138}},
  doi          = {{10.1080/14017431.2021.1875138}},
  year         = {{2021}},
}