Differences between local hospital and core laboratory interpretation of the admission electrocardiogram in patients with acute coronary syndromes and their relation to outcome.
In the prospective, multinational Global Registry of Acute Coronary Events (GRACE), patients diagnosed with non-ST-elevation acute coronary syndromes had their admission electrocardiogram independently evaluated by a central core laboratory, and its interpretation by the core laboratory and enrolling site were compared. One in 6 of these patients had clinically important features of left-bundle branch block or ST-segment deviation diagnosed by the core laboratory that were apparently not recognized at the local sites; this subgroup of patients was less likely to undergo risk stratification and revascularization. Importantly, failure to recognize these features as confirmed by the core laboratory in routine clinical practice was independently associated with higher mortality and recurrent myocardial infarction at 6 months (adjusted odds ratio 1.41, 95% confidence interval 1.01 to 1.96, p = 0.043). In conclusion, these findings underscore an urgent need to promote more accurate interpretation of electrocardiograms in contemporary clinical practice to bridge treatment gaps and improve patient outcome.
Yan
Raymond T
RT
Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Yan
Andrew T
AT
Allegrone
Jeanna
J
López-Sendón
José
J
Granger
Christopher B
CB
Gore
Joel M
JM
Budaj
Andrzej
A
Georgescu
Alina A
AA
Hassan
Quamrul
Q
Luchansky
Janna
J
Van de Werf
Frans
F
Goodman
Shaun G
SG
D000368:Aged; D003327:Coronary Disease / Q000175:diagnosis*; D003955:Diagnostic Tests, Routine / Q000592:standards*; D004562:Electrocardiography / Q000592:standards*; D005260:Female; D006801:Humans; D007753:Laboratories; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality; D011446:Prospective Studies