An initial exploration of subtraction electrocardiography to detect myocardial ischemia in the prehospital setting

Autor: Laura Burattini, Robbert J. de Winter, Ron J.G. Peters, Arie C. Maan, Peter W. Macfarlane, Pieter G. Postema, Eduard Bleijenberg, Martin J. Schalij, Sumche Man, Rob Adams, Agnese Sbrollini, Cees A. Swenne, Cornelia Cato ter Haar, Jan Bosch, Charles J. H. J. Kirchhof, Roderick W.C. Scherptong, Sophia Gripenstedt, Reza Alizadeh Dehnavi
Přispěvatelé: Cardiology, ACS - Atherosclerosis & ischemic syndromes, ACS - Heart failure & arrhythmias
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Adult
Male
Emergency Medical Services
medicine.medical_specialty
serial electrocardiography
Electrocardiographic myocardial ischemia
Myocardial ischemia
Adolescent
New Technologies
Myocardial Ischemia
030204 cardiovascular system & hematology
Logistic regression
Electrocardiography
Young Adult
03 medical and health sciences
0302 clinical medicine
Physiology (medical)
Internal medicine
medicine
Humans
ECG analysis
030212 general & internal medicine
cardiovascular diseases
Prehospital triage
Aged
Retrospective Studies
Aged
80 and over
subtraction electrocardiography
medicine.diagnostic_test
business.industry
Subtraction
Reproducibility of Results
Retrospective cohort study
General Medicine
Middle Aged
vectorcardiogram
Cardiology
Female
Triage
Cardiology and Cardiovascular Medicine
business
acute myocardial ischemia
Zdroj: Annals of Noninvasive Electrocardiology, 25(3), 238-249. WILEY
Annals of Noninvasive Electrocardiology
Annals of noninvasive electrocardiology, 25(3):e12722. Wiley-Blackwell
ISSN: 1082-720X
Popis: Background In the prehospital triage of patients presenting with symptoms suggestive of acute myocardial ischemia, reliable myocardial ischemia detection in the electrocardiogram (ECG) is pivotal. Due to large interindividual variability and overlap between ischemic and nonischemic ECG‐patterns, incorporation of a previous elective (reference) ECG may improve accuracy. The aim of the current study was to explore the potential value of serial ECG analysis using subtraction electrocardiography. Methods SUBTRACT is a multicenter retrospective observational study, including patients who were prehospitally evaluated for acute myocardial ischemia. For each patient, an elective previously recorded reference ECG was subtracted from the ambulance ECG. Patients were classified as myocardial ischemia cases or controls, based on the in‐hospital diagnosis. The diagnostic performance of subtraction electrocardiography was tested using logistic regression of 28 variables describing the differences between the reference and ambulance ECGs. The Uni‐G ECG Analysis Program was used for state‐of‐the‐art single‐ECG interpretation of the ambulance ECG. Results In 1,229 patients, the mean area‐under‐the‐curve of subtraction electrocardiography was 0.80 (95%CI: 0.77–0.82). The performance of our new method was comparable to single‐ECG analysis using the Uni‐G algorithm: sensitivities were 66% versus 67% (p‐value > .05), respectively; specificities were 80% versus 81% (p‐value > .05), respectively. Conclusions In our initial exploration, the diagnostic performance of subtraction electrocardiography for the detection of acute myocardial ischemia proved equal to that of state‐of‐the‐art automated single‐ECG analysis by the Uni‐G algorithm. Possibly, refinement of both algorithms, or even integration of the two, could surpass current electrocardiographic myocardial ischemia detection.
Databáze: OpenAIRE
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