title: The Comparison of Physician to Computer Interpreted Electrocardiograms on ST-elevation Myocardial Infarction Door-to-balloon Times.
abstract: OBJECTIVE
  The purpose of the project was to study the impact that immediate physician electrocardiogram (ECG) interpretation would have on door-to-balloon times in ST-elevation myocardial infarction (STEMI) as compared with computer-interpreted ECGs.
  
  
  METHODS
  This was a retrospective cohort study of 340 consecutive patients from September 2003 to December 2009 with STEMI who underwent emergent cardiac catheterization and percutaneous coronary intervention. Patients were stratified into 2 groups based on the computer-interpreted ECG interpretation: those with acute myocardial infarction identified by the computer interpretation and those not identified as acute myocardial infarction. Patients (n = 173) from September 2003 to June 2006 had their initial ECG reviewed by the triage nurse, while patients from July 2006 to December 2009 (n = 167) had their ECG reviewed by the emergency department physician within 10 minutes. Times for catheterization laboratory activation and percutaneous coronary intervention were recorded in all patients.
  
  
  RESULTS
  Of the 340 patients with confirmed STEMI, 102 (30%) patients were not identified by computer interpretation. Comparing the prior protocol of computer ECG to physician interpretation, the latter resulted in significant improvements in median catheterization laboratory activation time {19 minutes [interquartile range (IQR): 10-37] vs. 16 minutes [IQR: 8-29]; P < 0.029} and in median door-to-balloon time [113 minutes (IQR: 86-143) vs. 85 minutes (IQR: 62-106); P < 0.001].
  
  
  CONCLUSIONS
  The computer-interpreted ECG failed to identify a significant number of patients with STEMI. The immediate review of ECGs by an emergency physician led to faster activation of the catheterization laboratory, and door-to-balloon times in patients with STEMI.
authors.affiliation: From the *Department of Medicine, †Heart & Vascular Institute, ‡Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI; and §GE Healthcare, Milwaukee, WI.
authors.forename: Sagger
authors.initials: S
authors.lastname: Mawri
authors.forename: Alexander
authors.initials: A
authors.lastname: Michaels
authors.forename: Joseph
authors.initials: J
authors.lastname: Gibbs
authors.forename: Sunay
authors.initials: S
authors.lastname: Shah
authors.forename: Sunil
authors.initials: S
authors.lastname: Rao
authors.forename: Aaron
authors.initials: A
authors.lastname: Kugelmass
authors.forename: Natesh
authors.initials: N
authors.lastname: Lingam
authors.forename: Muhammad
authors.initials: M
authors.lastname: Arida
authors.forename: Gordon
authors.initials: G
authors.lastname: Jacobsen
authors.forename: Ian
authors.initials: I
authors.lastname: Rowlandson
authors.forename: Karthik
authors.initials: K
authors.lastname: Iyer
authors.forename: Akshay
authors.initials: A
authors.lastname: Khandelwal
authors.forename: James
authors.initials: J
authors.lastname: McCord
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003936:Diagnosis, Computer-Assisted / Q000706:statistics & numerical data*; D003951:Diagnostic Errors; D004562:Electrocardiography; D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000601:surgery; D009726:Nurses; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D010820:Physicians; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014218:Triage