title: ECG-based signal analysis technologies for evaluating patients with acute coronary syndrome: a systematic review.
abstract: OBJECTIVE
  Timely identification of cardiac ischemia is critical in patients with acute coronary syndrome (ACS). The first test is often the standard, resting 12-lead ECG. Given its limitations, signal analysis enhancements have been proposed. We summarize the published evidence for commercially available ECG-based signal analysis technologies.
  
  
  METHODS
  This is a systematic review of the English-language published literature.
  
  
  RESULTS
  Published evidence meeting inclusion criteria was available for two devices: PRIME ECG and LP 3000. Meta-analysis of eight studies estimated a 68.4% sensitivity (95% CI, 35.1%-89.7%) and 91.4% specificity (CI, 83.6%-95.7%) for the PRIME ECG, compared with 40.5% sensitivity (CI, 19.6%-65.5%) and 95.0% specificity (CI, 87.9%-98.0%) for the standard 12-lead ECG.
  
  
  CONCLUSIONS
  Existing evidence is insufficient to confidently inform the appropriate use of ECG-based signal analysis technologies for detecting ischemia or infarct in ACS. Further research is needed to determine in what circumstances, if any, these devices might precede, replace, or add to the standard ECG in test strategies for detecting ischemia or infarct in ACS.
authors.affiliation: Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC, USA.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Leisy
authors.forename: Remy R
authors.initials: RR
authors.lastname: Coeytaux
authors.forename: Galen S
authors.initials: GS
authors.lastname: Wagner
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Chung
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: McBroom
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Green
authors.forename: John W
authors.initials: JW
authors.lastname: Williams
authors.forename: Gillian D
authors.initials: GD
authors.lastname: Sanders
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000453:epidemiology*; D003936:Diagnosis, Computer-Assisted / Q000379:methods* / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted