Document Detail

Local hospital vs. core-laboratory interpretation of the admission electrocardiogram in acute coronary syndromes: increased mortality in patients with unrecognized ST-elevation myocardial infarction.
MedLine Citation:
PMID:  17989080     Owner:  NLM     Status:  MEDLINE    
AIMS: Previous analyses suggest only modest agreement between local site and core-laboratory (core-lab) electrocardiogram (ECG) interpretation in patients with acute coronary syndromes (ACSs); however, this has not been well examined outside of clinical trial populations. METHODS AND RESULTS: Patients (n = 5277 from 51 hospitals; 4916 with 1 year vital status) participating in the Canadian ACS Registry who were hospitalized with an ACS and had an interpretable initial ECG were included in this study. Core-lab ECG interpretation was blinded to site interpretation and outcomes. There was moderate agreement between site and core-lab regarding the predominant ECG findings (kappa = 0.49). Patients with core-lab-defined ST-elevation and cardiac marker elevation (n = 1202) not classified as ST-elevation by the site were less likely to receive acetylsalicylic acid (ASA) (90 vs. 96%, P < 0.0001), heparin (91 vs. 95%, P = 0.04), and reperfusion therapy (14 vs. 76%, P < 0.0001) than patients for whom there was agreement that ST-elevation was present. After adjusting for other validated prognostic factors, site-unrecognized ST-elevation was independently associated with higher mortality (odds ratio = 2.21; 95% CI, 1.46-3.36; P < 0.001). CONCLUSIONS: In patients with ACS, there was only moderate agreement between core-lab and site interpretation of the initial ECG. Site-unrecognized ST-elevation myocardial infarction was associated with underutilization of evidence-based therapies and increased 1-year mortality.
Ram Vijayaraghavan; Andrew T Yan; Mary Tan; David H Fitchett; Alina A Georgescu; Quamrul Hassan; Anatoly Langer; Shaun G Goodman;
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2007-11-06
Journal Detail:
Title:  European heart journal     Volume:  29     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-02     Completed Date:  2008-07-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  31-7     Citation Subset:  IM    
Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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MeSH Terms
Acute Coronary Syndrome / diagnosis,  mortality*
Aged, 80 and over
Electrocardiography / standards*
Laboratories / standards*
Middle Aged
Myocardial Infarction / diagnosis,  mortality*
Odds Ratio
Comment In:
Eur Heart J. 2008 Jan;29(1):1-3   [PMID:  18065751 ]

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