title: In search of the best method to predict acute coronary syndrome using only the electrocardiogram from the emergency department.
abstract: BACKGROUND
  The aim of this study was to compare different methods to predict acute coronary syndrome (ACS) using only data from a single electrocardiogram (ECG) in the emergency department (ED).
  
  
  METHODS
  We compared the ACS prediction abilities of classical ECG criteria, human expert ECG interpretation, a logistic regression model and an artificial neural network ensemble (ANN). The ED ECG and discharge diagnoses were retrieved for 861 patient visits to the ED for chest pain. Cross-validation was used to estimate the generalization performance of the logistic regression and the ANN model.
  
  
  RESULTS
  The logistic regression model had the overall best performance in predicting ACS with an area under the receiver operating characteristic curve of 0.88. The sensitivities of logistic regression, ANN, expert physicians, and classical ECG criteria were 95%, 95%, 82%, and 75%, respectively, and the specificities were 54%, 44%, 63%, and 69%.
  
  
  CONCLUSIONS
  Our logistic regression model was the best overall method to predict ACS, followed by our ANN. Decision support models have the potential to improve even experienced ECG readers' ability to predict ACS in the ED.
authors.affiliation: Department of Clinical Sciences, Section for Emergency Medicine, Lund University Hospital, Lund, Sweden. jakob@lundager.eu
authors.forename: Jakob L
authors.initials: JL
authors.lastname: Forberg
authors.forename: Michael
authors.initials: M
authors.lastname: Green
authors.forename: Jonas
authors.initials: J
authors.lastname: Björk
authors.forename: Mattias
authors.initials: M
authors.lastname: Ohlsson
authors.forename: Lars
authors.initials: L
authors.lastname: Edenbrandt
authors.forename: Hans
authors.initials: H
authors.lastname: Ohlin
authors.forename: Ulf
authors.initials: U
authors.lastname: Ekelund
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000465:Algorithms; D001185:Artificial Intelligence; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D010363:Pattern Recognition, Automated / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity