title: Agreement between cardiologists and fellows in interpretation of ischemic electrocardiographic changes in acute myocardial infarction.
abstract: BACKGROUND
  Time from symptom onset may not be the best indicator for choosing reperfusion therapy for patients presenting with acute ST-elevation myocardial infarction (STEMI); consequently ECG-based methods have been developed.
  
  
  METHODS
  This study evaluated the inter-observer agreement between experienced cardiologists and junior doctors in identifying the ECG findings of the pre-infarction syndrome (PIS) and evolving myocardial infarction (EMI). The ECGs of 353 STEMI patients were independently analyzed by two cardiologists, one fellow in cardiology, one fellow in internal medicine and a medical student. The last two were given a half-hour introduction of the PIS/EMI-algorithm.
  
  
  RESULTS
  The inter-observer reliability between all the investigators was found to be good according to kappa statistics (κ 0.632-0.790) for the whole study population. When divided into different subgroups, the inter-observer agreements were from good to very good between the cardiologists and the fellow in cardiology (κ 0.652 -0.813) and from moderate to good (κ 0.464-0.784) between the fellow in internal medicine, medical student and the others.
  
  
  CONCLUSIONS
  The PIS and EMI ECG patterns are reliably identified by experienced cardiologists and can be easily adopted by junior doctors.
authors.affiliation: Tays Heart Hospital, Tampere University Hospital, and Medical School, Tampere University, Tampere, Finland. Electronic address: Jyri.Koivumaki@sydansairaala.fi.
authors.forename: Jyri K
authors.initials: JK
authors.lastname: Koivumäki
authors.affiliation: Tays Heart Hospital, Tampere University Hospital, and Medical School, Tampere University, Tampere, Finland.
authors.forename: Kjell C
authors.initials: KC
authors.lastname: Nikus
authors.affiliation: University of Tampere, School of Public Health, Tampere Finland.
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.affiliation: Tays Heart Hospital, Tampere University Hospital, and Medical School, Tampere University, Tampere, Finland.
authors.forename: Essi
authors.initials: E
authors.lastname: Ryödi
authors.affiliation: Tays Heart Hospital, Tampere University Hospital, and Medical School, Tampere University, Tampere, Finland.
authors.forename: Joonas
authors.initials: J
authors.lastname: Leivo
authors.affiliation: Clinical Decision Support Solution Department, Philips Research North America, Briarcliff Manor, NY.
authors.forename: Sophia H
authors.initials: SH
authors.lastname: Zhou
authors.affiliation: Advanced Algorithm Research Center, Philips Healthcare, Andover, MA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Gregg
authors.affiliation: Heart Institute, Long Beach Memorial Medical Center, Long Beach, CA.
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Selvester
authors.affiliation: Tays Heart Hospital, Tampere University Hospital, and Medical School, Tampere University, Tampere, Finland.
authors.forename: Markku J
authors.initials: MJ
authors.lastname: Eskola
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002983:Clinical Competence; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology; D015588:Observer Variation; D015203:Reproducibility of Results
keywords: Ischemic electrocardiographic changes; STEMI