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The Comparison of Physician to Computer Interpreted Electrocardiograms on ST-elevation Myocardial Infarction Door-to-balloon Times

Mawri, Sagger MD; Michaels, Alexander MD; Gibbs, Joseph MD; Shah, Sunay MD; Rao, Sunil MD; Kugelmass, Aaron MD; Lingam, Natesh MD; Arida, Muhammad MD; Jacobsen, Gordon MS; Rowlandson, Ian MS; Iyer, Karthik MD; Khandelwal, Akshay MD; McCord, James MD

Critical Pathways in Cardiology: March 2016 - Volume 15 - Issue 1 - p 22–25
doi: 10.1097/HPC.0000000000000067
Original Articles

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].

Conclusion: 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.

From the *Department of Medicine, Heart & Vascular Institute, Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI; and §GE Healthcare, Milwaukee, WI.

Reprints: Sagger Mawri, MD, Clara Ford Pavilion One, 2799 W Grand Blvd, Detroit, MI 48202. E-mail:

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