The impact of numeric and graphic displays of ST-segment deviation levels on cardiologists' decisions of reperfusion therapy for patients with acute coronary occlusion

Magnus O. Nimmermark, John J. Wang, Charles Maynard, Mauricio G Cohen, Ian Gilcrist, John Heitner, Michael Hudson, Sebastian Palmeri, Galen S. Wagner, Olle Pahlm

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

The study purpose is to determine whether numeric and/or graphic ST measurements added to the display of the 12-lead electrocardiogram (ECG) would influence cardiologists' decision to provide myocardial reperfusion therapy. Twenty ECGs with borderline ST-segment deviation during elective percutaneous coronary intervention and 10 controls before balloon inflation were included. Only 5 of the 20 ECGs during coronary balloon occlusion met the 2007 American Heart Association guidelines for ST-elevation myocardial infarction (STEMI). Fifteen cardiologists read 4 sets of these ECGs as the basis for a "yes/no" reperfusion therapy decision. Sets 1 and 4 were the same 12-lead ECGs alone. Set 2 also included numeric ST-segment measurements, and set 3 included both numeric and graphically displayed ST measurements ("ST Maps"). The mean (range) positive reperfusion decisions were 10.6 (2-15), 11.4 (1-19), 9.7 (2-14), and 10.7 (1-15) for sets 1 to 4, respectively. The accuracies of the observers for the 5 STEMI ECGs were 67%, 69%, and 77% for the standard format, the ST numeric format, and the ST graphic format, respectively. The improved detection rate (77% vs 67%) with addition of both numeric and graphic displays did achieve statistical significance (P <.025). The corresponding specificities for the 10 control ECGs were 85%, 79%, and 89%, respectively. In conclusion, a wide variation of reperfusion decisions was observed among clinical cardiologists, and their decisions were not altered by adding ST deviation measurements in numeric and/or graphic displays. Acute coronary occlusion detection rate was low for ECGs meeting STEMI criteria, and this was improved by adding ST-segment measurements in numeric and graphic forms. These results merit further study of the clinical value of this technique for improved acute coronary occlusion treatment decision support.

Original languageEnglish
Pages (from-to)502-508
Number of pages7
JournalJournal of Electrocardiology
Volume44
Issue number5
DOIs
StatePublished - Sep 1 2011

Fingerprint

Coronary Occlusion
Reperfusion
Electrocardiography
Therapeutics
Balloon Occlusion
Myocardial Reperfusion
Cardiologists
Economic Inflation
Percutaneous Coronary Intervention
Guidelines

Keywords

  • Electrocardiogram
  • Myocardial infarction
  • Reperfusion
  • ST-segments

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The impact of numeric and graphic displays of ST-segment deviation levels on cardiologists' decisions of reperfusion therapy for patients with acute coronary occlusion. / Nimmermark, Magnus O.; Wang, John J.; Maynard, Charles; Cohen, Mauricio G; Gilcrist, Ian; Heitner, John; Hudson, Michael; Palmeri, Sebastian; Wagner, Galen S.; Pahlm, Olle.

In: Journal of Electrocardiology, Vol. 44, No. 5, 01.09.2011, p. 502-508.

Research output: Contribution to journalArticle

Nimmermark, Magnus O. ; Wang, John J. ; Maynard, Charles ; Cohen, Mauricio G ; Gilcrist, Ian ; Heitner, John ; Hudson, Michael ; Palmeri, Sebastian ; Wagner, Galen S. ; Pahlm, Olle. / The impact of numeric and graphic displays of ST-segment deviation levels on cardiologists' decisions of reperfusion therapy for patients with acute coronary occlusion. In: Journal of Electrocardiology. 2011 ; Vol. 44, No. 5. pp. 502-508.
@article{f6a6535991f845e28301dcf6044d3b6e,
title = "The impact of numeric and graphic displays of ST-segment deviation levels on cardiologists' decisions of reperfusion therapy for patients with acute coronary occlusion",
abstract = "The study purpose is to determine whether numeric and/or graphic ST measurements added to the display of the 12-lead electrocardiogram (ECG) would influence cardiologists' decision to provide myocardial reperfusion therapy. Twenty ECGs with borderline ST-segment deviation during elective percutaneous coronary intervention and 10 controls before balloon inflation were included. Only 5 of the 20 ECGs during coronary balloon occlusion met the 2007 American Heart Association guidelines for ST-elevation myocardial infarction (STEMI). Fifteen cardiologists read 4 sets of these ECGs as the basis for a {"}yes/no{"} reperfusion therapy decision. Sets 1 and 4 were the same 12-lead ECGs alone. Set 2 also included numeric ST-segment measurements, and set 3 included both numeric and graphically displayed ST measurements ({"}ST Maps{"}). The mean (range) positive reperfusion decisions were 10.6 (2-15), 11.4 (1-19), 9.7 (2-14), and 10.7 (1-15) for sets 1 to 4, respectively. The accuracies of the observers for the 5 STEMI ECGs were 67{\%}, 69{\%}, and 77{\%} for the standard format, the ST numeric format, and the ST graphic format, respectively. The improved detection rate (77{\%} vs 67{\%}) with addition of both numeric and graphic displays did achieve statistical significance (P <.025). The corresponding specificities for the 10 control ECGs were 85{\%}, 79{\%}, and 89{\%}, respectively. In conclusion, a wide variation of reperfusion decisions was observed among clinical cardiologists, and their decisions were not altered by adding ST deviation measurements in numeric and/or graphic displays. Acute coronary occlusion detection rate was low for ECGs meeting STEMI criteria, and this was improved by adding ST-segment measurements in numeric and graphic forms. These results merit further study of the clinical value of this technique for improved acute coronary occlusion treatment decision support.",
keywords = "Electrocardiogram, Myocardial infarction, Reperfusion, ST-segments",
author = "Nimmermark, {Magnus O.} and Wang, {John J.} and Charles Maynard and Cohen, {Mauricio G} and Ian Gilcrist and John Heitner and Michael Hudson and Sebastian Palmeri and Wagner, {Galen S.} and Olle Pahlm",
year = "2011",
month = "9",
day = "1",
doi = "10.1016/j.jelectrocard.2011.06.009",
language = "English",
volume = "44",
pages = "502--508",
journal = "Journal of Electrocardiology",
issn = "0022-0736",
publisher = "Churchill Livingstone",
number = "5",

}

TY - JOUR

T1 - The impact of numeric and graphic displays of ST-segment deviation levels on cardiologists' decisions of reperfusion therapy for patients with acute coronary occlusion

AU - Nimmermark, Magnus O.

AU - Wang, John J.

AU - Maynard, Charles

AU - Cohen, Mauricio G

AU - Gilcrist, Ian

AU - Heitner, John

AU - Hudson, Michael

AU - Palmeri, Sebastian

AU - Wagner, Galen S.

AU - Pahlm, Olle

PY - 2011/9/1

Y1 - 2011/9/1

N2 - The study purpose is to determine whether numeric and/or graphic ST measurements added to the display of the 12-lead electrocardiogram (ECG) would influence cardiologists' decision to provide myocardial reperfusion therapy. Twenty ECGs with borderline ST-segment deviation during elective percutaneous coronary intervention and 10 controls before balloon inflation were included. Only 5 of the 20 ECGs during coronary balloon occlusion met the 2007 American Heart Association guidelines for ST-elevation myocardial infarction (STEMI). Fifteen cardiologists read 4 sets of these ECGs as the basis for a "yes/no" reperfusion therapy decision. Sets 1 and 4 were the same 12-lead ECGs alone. Set 2 also included numeric ST-segment measurements, and set 3 included both numeric and graphically displayed ST measurements ("ST Maps"). The mean (range) positive reperfusion decisions were 10.6 (2-15), 11.4 (1-19), 9.7 (2-14), and 10.7 (1-15) for sets 1 to 4, respectively. The accuracies of the observers for the 5 STEMI ECGs were 67%, 69%, and 77% for the standard format, the ST numeric format, and the ST graphic format, respectively. The improved detection rate (77% vs 67%) with addition of both numeric and graphic displays did achieve statistical significance (P <.025). The corresponding specificities for the 10 control ECGs were 85%, 79%, and 89%, respectively. In conclusion, a wide variation of reperfusion decisions was observed among clinical cardiologists, and their decisions were not altered by adding ST deviation measurements in numeric and/or graphic displays. Acute coronary occlusion detection rate was low for ECGs meeting STEMI criteria, and this was improved by adding ST-segment measurements in numeric and graphic forms. These results merit further study of the clinical value of this technique for improved acute coronary occlusion treatment decision support.

AB - The study purpose is to determine whether numeric and/or graphic ST measurements added to the display of the 12-lead electrocardiogram (ECG) would influence cardiologists' decision to provide myocardial reperfusion therapy. Twenty ECGs with borderline ST-segment deviation during elective percutaneous coronary intervention and 10 controls before balloon inflation were included. Only 5 of the 20 ECGs during coronary balloon occlusion met the 2007 American Heart Association guidelines for ST-elevation myocardial infarction (STEMI). Fifteen cardiologists read 4 sets of these ECGs as the basis for a "yes/no" reperfusion therapy decision. Sets 1 and 4 were the same 12-lead ECGs alone. Set 2 also included numeric ST-segment measurements, and set 3 included both numeric and graphically displayed ST measurements ("ST Maps"). The mean (range) positive reperfusion decisions were 10.6 (2-15), 11.4 (1-19), 9.7 (2-14), and 10.7 (1-15) for sets 1 to 4, respectively. The accuracies of the observers for the 5 STEMI ECGs were 67%, 69%, and 77% for the standard format, the ST numeric format, and the ST graphic format, respectively. The improved detection rate (77% vs 67%) with addition of both numeric and graphic displays did achieve statistical significance (P <.025). The corresponding specificities for the 10 control ECGs were 85%, 79%, and 89%, respectively. In conclusion, a wide variation of reperfusion decisions was observed among clinical cardiologists, and their decisions were not altered by adding ST deviation measurements in numeric and/or graphic displays. Acute coronary occlusion detection rate was low for ECGs meeting STEMI criteria, and this was improved by adding ST-segment measurements in numeric and graphic forms. These results merit further study of the clinical value of this technique for improved acute coronary occlusion treatment decision support.

KW - Electrocardiogram

KW - Myocardial infarction

KW - Reperfusion

KW - ST-segments

UR - http://www.scopus.com/inward/record.url?scp=80052143874&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80052143874&partnerID=8YFLogxK

U2 - 10.1016/j.jelectrocard.2011.06.009

DO - 10.1016/j.jelectrocard.2011.06.009

M3 - Article

VL - 44

SP - 502

EP - 508

JO - Journal of Electrocardiology

JF - Journal of Electrocardiology

SN - 0022-0736

IS - 5

ER -