Diagnostic accuracy of a prehospital electrocardiogram rule-based algorithm for ST-elevation myocardial infarction: results from a population-wide project

This study reviewed the diagnostic accuracy of the prehospital electrocardiogram (PHECG) rule-based algorithm for ST-elevation myocardial infarction (STEMI) universally utilised in Hong Kong. This prospective observational study was linked to a population-wide project. We analysed 2210 PHECGs perfor...

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Vydáno v:Hong Kong medical journal = Xianggang yi xue za zhi Ročník 30; číslo 4; s. 271
Hlavní autoři: Lai, J H Y, Lui, C T, Chan, T W T, Wong, B C P, Tsui, M S H, Wan, B K A, Mok, K L
Médium: Journal Article
Jazyk:angličtina
Vydáno: China Hong Kong Academy of Medicine 01.08.2024
Témata:
Accuracy
Aged
Agreements
Algorithms
Cardiovascular disease
Chest Pain - diagnosis
Chest Pain - etiology
Electrocardiography
Electrocardiography - methods
Emergency medical care
Emergency Medical Services - methods
Female
Heart attacks
Hong Kong
Hospitals
Humans
Kappa coefficient
Male
Middle Aged
Pain
Patients
Prevalence
Prospective Studies
Sensitivity and Specificity
ST Elevation Myocardial Infarction - diagnosis
Hong Kong
Hong Kong China
China
Germany
Myocardial infarction
Electrocardiography
Algorithms
Emergency service, hospital
Emergency medical services
ISSN:1024-2708, 2226-8707
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Shrnutí:This study reviewed the diagnostic accuracy of the prehospital electrocardiogram (PHECG) rule-based algorithm for ST-elevation myocardial infarction (STEMI) universally utilised in Hong Kong. This prospective observational study was linked to a population-wide project. We analysed 2210 PHECGs performed on patients who presented to the emergency medical service (EMS) with chest pain from 1 October to 31 December 2021. The diagnostic accuracy of the adopted rulebased algorithm, the Hannover Electrocardiogram System, was evaluated using the adjudicated blinded rating by two investigators as the primary reference standard. Diagnostic accuracy was also evaluated using the attending emergency physician's diagnosis and the diagnosis on hospital discharge as secondary reference standards. The prevalence of STEMI was 5.1% (95% confidence interval [CI]=4.2%-6.1%). Using the adjudicated blinded rating by investigators as the reference standard, the rule-based PHECG algorithm had a sensitivity of 94.6% (95% CI=88.2%-97.8%), specificity of 87.9% (95% CI=86.4%-89.2%), positive predictive value of 29.4% (95% CI=24.8%-34.4%), and negative predictive value of 99.7% (95% CI=99.3%-99.9%) [all P<0.05]. The rule-based PHECG algorithm that is widely used in Hong Kong demonstrated high sensitivity and fair specificity for the diagnosis of STEMI.
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ISSN:1024-2708
2226-8707
DOI:10.12809/hkmj2310827