An assessment of ST-segment measurement variability between two core electrocardiogram laboratories

Abstract Objectives We evaluated inter-reader agreement of the ST-segment between two electrocardiogram (ECG) core laboratories. Background Accurate measurement of the ST-segment is key to diagnosis and management of acute coronary syndromes (ACS). Clinical trials also rely on adherence to the pre-s...

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Bibliographic Details
Published in:Journal of electrocardiology 2014, Vol.47 (1), p.38-44
Main Authors: Dianati Maleki, Neda, MD, Stocke, Karen, MBA, Zheng, Yinggan, MA, MEd, Westerhout, Cynthia M., PhD, Fu, Yuling, MD, Chaitman, Bernard R., MD, FACC, Awad, Ahmed, MD, Jagasia, Pushpa, MD, Armstrong, Paul W., MD, FACC
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Aged
Alberta
Cardiovascular
Electrocardiogram
Electrocardiography - methods
Electrocardiography - statistics & numerical data
Female
Humans
Laboratories, Hospital - statistics & numerical data
Male
Middle Aged
Missouri
Myocardial Infarction - diagnosis
Observer Variation
Reliability
Reproducibility of Results
Sensitivity and Specificity
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Summary:Abstract Objectives We evaluated inter-reader agreement of the ST-segment between two electrocardiogram (ECG) core laboratories. Background Accurate measurement of the ST-segment is key to diagnosis and management of acute coronary syndromes (ACS). Clinical trials also rely on adherence to the pre-specified ECG eligibility criteria. Methods 150 patients (100 ST-segment elevation (STE)-ACS, 50 non-STE-ACS) were selected. An experienced ECG reader from each laboratory measured ST-segment deviation on the baseline ECGs (nearest 0.1 mm). Results ∑ ST-segment deviation showed excellent inter-reader agreement (R = 0.965, intraclass correlation coefficient (ICC) 0.949, 95% CI (0.930–0.963)). Similar agreement was observed when ∑ ST-segment elevation (∑ STE) and ∑ ST-segment depression (∑ STD) were assessed separately. Better agreement was evident in STE-ACS cohort (ICC (95% CI): 0.968 (0.953–0.978, 0.969 (0.954–0.979), 0.931 (0.899–0.953)) compared to NSTE-ACS patients (ICC (95% CI): 0.860 (0.768–0.917), 0.816 (0.699–0.890), 0.753 (0.605–0.851) across measurement of ∑ ST-segment deviation, ∑ STE, and ∑ STD. Conclusions We demonstrated excellent agreement on ST-segment measurements between two experienced readers from two ECG core laboratories.
ISSN:0022-0736
1532-8430
DOI:10.1016/j.jelectrocard.2013.10.005