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Delays in reperfusion of STEMI are associated with worse outcomes. In 2016, the median door to device (D2D) time for those with STEMI self-presenting to an emergency department (ED) in our region was 119 minutes. Those over the age of 75 years and females experienced longer delays. One source of delay was ECG interpretation and cardiac catheterization lab (CCL) activation. Automated ECG interpretation and CCL activation may reduce D2D time in this population. We sought to evaluate the accuracy of a software in detecting STEMI, and the potential effect in reducing D2D.
We identified patients who presented to Emergency Departments (EDs) in Winnipeg, Manitoba, Canada from January 2015 to September 2016 who were subsequently diagnosed with STEMI and sent to the regional CCL for primary PCI. We reviewed the ECGs that triggered CCL activation and determined the sensitivity and specificity of software interpretation of the ECG (Marquette 12SL, MUSE, GE Healthcare, Finland). A third physician’s blinded interpretation of the ECG was considered the “gold standard” and 95% confidence intervals were calculated using Clopper-Pearson Method. The potential reduction in D2D was calculated by eliminating the time from ECG to notification of the on-call cardiologist.
Results are summarized in Table 1.
Software interpretation of STEMI conferred a potential 17-minute reduction in D2D time. The reduction was greatest in those >75 years and women, populations that have longer D2D times and worse outcomes. Further study is needed to evaluate the real world effect of such a system in the ED.
CORONARY: Acute Myocardial Infarction