Local hospital vs. core-laboratory interpretation of the admission electrocardiogram in acute coronary syndromes: increased mortality in patients with unrecognized ST-elevation myocardial infarction

• Published in: European heart journal 2008-01, Vol.29 (1), p.31-37
• Main Authors: Vijayaraghavan, Ram, Yan, Andrew T., Tan, Mary, Fitchett, David H., Georgescu, Alina A., Hassan, Quamrul, Langer, Anatoly, Goodman, Shaun G.
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - mortality; Acute coronary syndromes; Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Canada; Cardiology. Vascular system; Coronary heart disease; Electrocardiogram; Electrocardiography - standards; Female; Heart; Humans; Laboratories - standards; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocarditis. Cardiomyopathies; Odds Ratio; Prognosis
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehm503

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 (κ = 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.