title: The impact of numeric and graphic displays of ST-segment deviation levels on cardiologists' decisions of reperfusion therapy for patients with acute coronary occlusion.
abstract: The study purpose is to determine whether numeric and/or graphic ST measurements added to the display of the 12-lead electrocardiogram (ECG) would influence cardiologists' decision to provide myocardial reperfusion therapy. Twenty ECGs with borderline ST-segment deviation during elective percutaneous coronary intervention and 10 controls before balloon inflation were included. Only 5 of the 20 ECGs during coronary balloon occlusion met the 2007 American Heart Association guidelines for ST-elevation myocardial infarction (STEMI). Fifteen cardiologists read 4 sets of these ECGs as the basis for a "yes/no" reperfusion therapy decision. Sets 1 and 4 were the same 12-lead ECGs alone. Set 2 also included numeric ST-segment measurements, and set 3 included both numeric and graphically displayed ST measurements ("ST Maps"). The mean (range) positive reperfusion decisions were 10.6 (2-15), 11.4 (1-19), 9.7 (2-14), and 10.7 (1-15) for sets 1 to 4, respectively. The accuracies of the observers for the 5 STEMI ECGs were 67%, 69%, and 77% for the standard format, the ST numeric format, and the ST graphic format, respectively. The improved detection rate (77% vs 67%) with addition of both numeric and graphic displays did achieve statistical significance (P < .025). The corresponding specificities for the 10 control ECGs were 85%, 79%, and 89%, respectively. In conclusion, a wide variation of reperfusion decisions was observed among clinical cardiologists, and their decisions were not altered by adding ST deviation measurements in numeric and/or graphic displays. Acute coronary occlusion detection rate was low for ECGs meeting STEMI criteria, and this was improved by adding ST-segment measurements in numeric and graphic forms. These results merit further study of the clinical value of this technique for improved acute coronary occlusion treatment decision support.
authors.affiliation: Lund University, Lund, Sweden.
authors.forename: Magnus O
authors.initials: MO
authors.lastname: Nimmermark
authors.forename: John J
authors.initials: JJ
authors.lastname: Wang
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.forename: Mauricio
authors.initials: M
authors.lastname: Cohen
authors.forename: Ian
authors.initials: I
authors.lastname: Gilcrist
authors.forename: John
authors.initials: J
authors.lastname: Heitner
authors.forename: Michael
authors.initials: M
authors.lastname: Hudson
authors.forename: Sebastian
authors.initials: S
authors.lastname: Palmeri
authors.forename: Galen S
authors.initials: GS
authors.lastname: Wagner
authors.forename: Olle
authors.initials: O
authors.lastname: Pahlm
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D016022:Case-Control Studies; D003626:Data Display; D003657:Decision Making; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D012680:Sensitivity and Specificity