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Accurate and rapid electrocardiographic interpretation is of crucial importance in acute coronary syndrome(ACS). Computerized electrocardiographic algorithms are often used in out-of-hospital settings. Their accuracy should be carefully validated in ACS, particularly in ST-elevation myocardial infarction. This stu dy evaluated the comparative accuracy of lead-specific computer-based versus m anual measurements of the J-point, ST-segment, and T-wave deviations in stand ard 12-lead electrocardiograms(ECGs)(excluding lead aVR). Sixty-nine consecuti ve patients with suspected ACS were included. The interobserver reliability in t he determination of ST-segment deviation< 0.2 mV in leads V2 and V3 was very go od(κ=0.94 and 0.93, respectively). Agreement between a cardiologist and the com puter regarding ST elevation< 0.2 mV in lead V2 was moderate(κ=0.72)and in V3 w as very good(κ=0.85). For ST depression or elevation< 0.05 mV in lead LIII, agr eement was good and moderate(κ=0.79 and 0.51, respectively). Bland-Altman anal ysis demonstrated clinically acceptable limit s of agreement comparing measurements of the J point and the T wave, but clinica lly inadequate limits of agreement with respect to ST-segment deviation, betwee n the electrocardiographer and the computer. The optimal cut-off points were 0. 115 mV(sensitivity 89%, specificity 98%)for the computer program to detect ST elevation< 0.2 mV and 0.045 mV(sensitivity 74%, specificity 99%)for revealing ST elevation< 0.1 mV. It was found that automatically measured ST-segment devia tions were smaller than those manually measured. In conclusion, a correction sho uld be performed to obtain optimal results in the automated analysis of ECGs, be cause the results have important implications for clinical decision making.
Accurate and rapid electrocardiographic interpretation is of crucial importance in acute coronary syndrome (ACS). Computerized electrocardiographic algorithms are often used in out-of-hospital settings. Their accuracy should be carefully validated in ACS, particularly in ST- elevation myocardial infarction. This stu dy evaluated the comparative accuracy of lead-specific computer-based versus m anual measurements of the J-point, ST-segment, and T-wave deviations in stand ard 12-lead electrocardiograms (ECGs) (excluding lead aVR). Sixty-nine The interobserver reliability in t he determination of ST-segment deviation <0.2 mV in leads V2 and V3 was very go od (κ = 0.94 and 0.93, respectively). Agreement between a cardiologist and the com puter regarding ST elevation <0.2 mV in lead V2 was moderate (κ = 0.72) and in V3 w as very good (κ = 0.85). For ST depression or elevation <0.05 mV in lead LIII, agr eement was good and moderate (κ = 0.79 and 0.5 1, respectively). Bland-Altman anal ysis demonstrated clinically acceptable limit s of agreement comparing measurements of the J point and the T wave, but clinica lly inadequate limits of agreement with respect to ST-segment deviation, betwee n the electrocardiographer and the computer . The optimal cut-off points were 0. 115 mV (sensitivity 89%, specificity 98%) for the computer program to detect ST elevation <0.2 mV and 0.045 mV (specificity 99%) for revealing ST elevation <0.1 It has found that automatically measured ST-segment devia tions were smaller than those manually measured. In conclusion, a correction sho uld be performed to obtain the optimal results in the automated analysis of ECGs, be cause the results have important implications for clinical decision making.