Agreement between cardiologists and fellows in interpretation of ischemic electrocardiographic changes in acute myocardial infarction

J Electrocardiol. 2015 Mar-Apr;48(2):213-7. doi: 10.1016/j.jelectrocard.2014.11.012. Epub 2014 Nov 28.

Abstract

Background: Time from symptom onset may not be the best indicator for choosing reperfusion therapy for patients presenting with acute ST-elevation myocardial infarction (STEMI); consequently ECG-based methods have been developed.

Methods: This study evaluated the inter-observer agreement between experienced cardiologists and junior doctors in identifying the ECG findings of the pre-infarction syndrome (PIS) and evolving myocardial infarction (EMI). The ECGs of 353 STEMI patients were independently analyzed by two cardiologists, one fellow in cardiology, one fellow in internal medicine and a medical student. The last two were given a half-hour introduction of the PIS/EMI-algorithm.

Results: The inter-observer reliability between all the investigators was found to be good according to kappa statistics (κ 0.632-0.790) for the whole study population. When divided into different subgroups, the inter-observer agreements were from good to very good between the cardiologists and the fellow in cardiology (κ 0.652 -0.813) and from moderate to good (κ 0.464-0.784) between the fellow in internal medicine, medical student and the others.

Conclusions: The PIS and EMI ECG patterns are reliably identified by experienced cardiologists and can be easily adopted by junior doctors.

Keywords: Ischemic electrocardiographic changes; STEMI.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Algorithms
  • Clinical Competence*
  • Coronary Angiography
  • Electrocardiography*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / classification
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / physiopathology
  • Observer Variation
  • Reproducibility of Results