UCSF CME STEMI Diaganosis
[Pages:50]ST--Segment
E levation
Myocardial
Infarction Challenges
in
Diagnosis &
Current
Measures
of
Quality
James
M.
McCabe,
MD,
FACC,
F AHA Cath Lab
Director,
U niversity
o f
Washington
Disclosures
? I,
James
McCabe,
have
no
relevant
financial
disclosures
DONNELLY, EILEEN
03-AUG-1925 (84 yr) Female Unknown
Room:904 Loc:206 Option:1
Vent. rate PR interval QRS duration QT/QTc P-R-T axes
ID:002653467
62 202
76 468/475
25 0
BPM ms ms ms -28
02-JAN-2010 22:27:29
BRIGHAM & WOMEN'S/FAULKNER HOSP.
Normal sinus rhythm with sinus arrhythmia Minimal voltage criteria for LVH, may be normal variant Cannot rule out Anterior myocardial infarction , age undetermined Abnormal ECG No previous ECGs available
Technician: Test ind:410.12
Referred by: PETER LIBBY, M.D.
Confirmed By: DALE ADLER M.D.
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
V1
II
V5 25mm/s 10mm/mV 150Hz 8.0.1 12SL 239 CID: 1
EID:12 EDT: 15:12 05-JAN-2010 ORDER:
ACCOUNT: 002653467 Page 1 of 1
Analysis of intermediate risk ECGs alone for STEMI diagnosis
? 36
ECGs
for
which
a
cath lab
activation
had
occured
? 124
physicians
at
various
levels
surveyed ? All
cases
d escribed
as
"moderate
risk
of
acute
coronary
syndrome"
without
further
clinical
details
provided ? Q:
Is
there
a
blocked
coronary
artery
present
causing
a
STEMI?
(please
provide
your
best
ECG
51
guess)
McCabe
et
a l.
J AHA.
2013.
Reader
Performance
by
Experience
Sens Spec PPV NPV Kappa C
Computer
A lgorithm 45.8 83.3 84.6 43.5 n/a 0.65
All
P articipants
65.4 79.1 86.3 53.3 0.35 0.72
By
Training
Level
All
R esidents
61.3 72.5 81.7 48.2 0.27 0.67
All
F ellows
62.9 86.1 90 53.7 0.41 0.74
All
A ttendings 70.3 79.2 87.1 57.1 0.39 0.75
McCabe et al. JAHA . 2013
Accuracy
of
ECG
Read
for
STEMI
Residents Fellows Attendings
Experience
(per
year)
OR
95%
CI
p
Value
----
----
----
1.26 Exper1i.e0n2-c-1e.5
6Matters!0.03
1.645%
increase1d.1
o 9-d-1d.7s7
o f
accura ................
................
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