title: Accuracy of computer-interpreted electrocardiography in selecting patients for thrombolytic therapy. MITI Project Investigators.
abstract: A prehospital computer-interpreted electrocardiogram (ECG) was obtained in 1,189 patients with chest pain of suspected cardiac origin during an ongoing trial of prehospital thrombolytic therapy in acute myocardial infarction. Electrocardiograms were performed by paramedics 1.5 +/- 1.2 h after the onset of symptoms. Of 391 patients with evidence of acute myocardial infarction, 202 (52%) were identified as having ST segment elevation (acute injury) by the computer-interpreted ECG compared with 259 (66%) by an electrocardiographer (p less than 0.001). Of 798 patients with chest pain but no infarction, 785 (98%) were appropriately excluded by computer compared with 757 (95%) by an electrocardiographer (p less than 0.001). The positive predictive value of the computer- and physician-interpreted ECG was, respectively, 94% and 86% and the negative predictive value was 81% and 85%. Prehospital screening of possible candidates for thrombolytic therapy with the aid of a computerized ECG is feasible, highly specific and with further enhancement can speed the care of all patients with acute myocardial infarction.
authors.affiliation: Department of Medicine, University of Washington, Seattle.
authors.forename: P J
authors.initials: PJ
authors.lastname: Kudenchuk
authors.forename: M T
authors.initials: MT
authors.lastname: Ho
authors.forename: W D
authors.initials: WD
authors.lastname: Weaver
authors.forename: P E
authors.initials: PE
authors.lastname: Litwin
authors.forename: J S
authors.initials: JS
authors.lastname: Martin
authors.forename: M S
authors.initials: MS
authors.lastname: Eisenberg
authors.forename: A P
authors.initials: AP
authors.lastname: Hallstrom
authors.forename: L A
authors.initials: LA
authors.lastname: Cobb
authors.forename: J W
authors.initials: JW
authors.lastname: Kennedy
mesh_terms: D000465:Algorithms; D004562:Electrocardiography / Q000379:methods*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D015912:Thrombolytic Therapy