Abstract 17782: In the Prehospital Setting the Glasgow Algorithm for Electrocardiogram Analysis is not Specific in Patients With Suspected ST Elevation Myocardial Infarction
Introduction: The University of Glasgow 12-Lead ECG Analysis Algorithm (GA) has a reported sensitivity of 78% and specificity of 94% for the diagnosis of STEMI in the prehospital setting.
Aim: To assess the accuracy of the GA in the prehospital setting in patients with suspected STEMI.
Methods: Prehospital ECGs from patients with suspected ACS between 2010 and 2013 on LIFEPAK15 units with GA interpretation capability were transmitted to interventional cardiologists by paramedics. Independent interpretation of ST elevation criteria of ≥1mm (except ≥2mm in men ≥ 40 years, ≥2.5mm in men < 40 years or ≥ 1.5 mm in women in leads V1-3) in ≥2 contiguous leads, was performed retrospectively by two cardiology fellows with 20% cross-reading by an interventional cardiologist; MI adjudication used the Third Universal Definition. Disagreements were resolved by consensus.
Results: Of the 580 transmitted ECGs, 91(7.5%) were excluded (missing information or duplicate/serial). Of the remaining 489 transmitted ECGs, 342 (70%) were performed on patients with chest pain, and 434 (89%) were ‘GA STEMI positive’ and 55 (11.2%) were ‘GA STEMI negative’. Independent interpretation of the ‘GA STEMI positive’ ECGs found 60% (260/434) met STEMI criteria and 40% (174/434) did not meet STEMI criteria. Of the 260 ECGs that met STEMI criteria, 252 (96.9%) had STEMI and 8 (3.1%) did not have an ACS. Of 174 ECGs that did not meet STEMI criteria, 5 (2.9%) were STEMI and 169 (97%) were not STEMI (23 NSTEMI and 146 not ACS). Of the 434 ‘GA STEMI positive’ transmissions, the cardiac catheterization laboratory (CCL) was activated only 237 times (54.6%) - 231 were STEMI and 6 were not ACS.
Conclusions: We report, contrary to previous studies, that application of the GA is not accurate when used alone in the prehospital setting for the diagnosis of STEMI. Interventional cardiologist ECG interpretation lead to significantly fewer prehospital CCL activations than would have occurred by merely applying GA criteria.
- Interventional cardiology
- Acute coronary syndromes
- Myocardial infarction, STEMI
Author Disclosures: A. Faour: None. O. GIbbs: None. C. Cherrett: None. K. Lintern: None. R. Rajaratnam: None. C. Juergens: None. J. French: None.
- © 2016 by American Heart Association, Inc.