Ahmad Alrawashdeh, Samar Ihtoub, Zaid I Alkhatib, Mahmoud Alwidyan, Yousef S Khader, Sukaina Rawashdeh, Saeed Alqahtani, Dion Stub, Rahaf Alhamouri, Islam E Alkhazali, Ziad Nehme
{"title":"院前心电图解释方法st段抬高心肌梗死检测和导管实验室激活：系统回顾和荟萃分析。","authors":"Ahmad Alrawashdeh, Samar Ihtoub, Zaid I Alkhatib, Mahmoud Alwidyan, Yousef S Khader, Sukaina Rawashdeh, Saeed Alqahtani, Dion Stub, Rahaf Alhamouri, Islam E Alkhazali, Ziad Nehme","doi":"10.22037/aaemj.v13i1.2627","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>The diagnostic accuracies of different electrocardiography (ECG) interpretation methods remain unclear. Therefore, this study aimed to systematically evaluate and compare the diagnostic accuracy of prehospital 12-lead ECG interpretation methods for identifying ST-elevation myocardial infarction (STEMI) and activating cardiac catheterization laboratories (CCLs).</p><p><strong>Methods: </strong>A comprehensive search was conducted in Medline, Scopus, and CINAHL databases up to August 2024. Two reviewers independently selected studies that assessed the diagnostic accuracy of prehospital 12-lead ECG in real-time STEMI identification and CCL activation. Pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated using bivariate generalized mixed-effects regression models or random-effects meta-analysis as appropriate. The quality of the included studies was assessed using the QUADAS-2 tool.</p><p><strong>Results: </strong>Thirty-six studies involving 67,168 patients were included. Overall, for STEMI identification, the pooled AUC of ECG was 0.96 (95%CI:0.94-0.98), sensitivity was 80% (95% CI, 69-88%), specificity was 97% (95%CI: 94-98%), and DOR was 114 (95%CI: 59-222). Ambulance clinicians achieved the highest DOR (264; 95%CI: 33-2125), followed by transmission method (136; 95%CI, 59-312) and computer-assisted analysis (78; 95%CI: 33-186). Transmission method demonstrated superior specificity (0.98; 95%CI: 0.94-0.99) and the lowest rates of inappropriate (13.2%; 95% CI: 8.6%-19.2%), and false-positive (11.0%; 95%CI: 6.9%-15.0%) CCL activations.</p><p><strong>Conclusion: </strong>All prehospital ECG interpretation methods yielded acceptable diagnostic accuracy for STEMI identification; however, transmission offered the greatest specificity and fewer unnecessary CCL activations. Adopting transmission-based strategies, where feasible, and enhancing training and decision support for ambulance clinicians may improve prehospital STEMI detection and resource utilization.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"13 1","pages":"e47"},"PeriodicalIF":2.0000,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145131/pdf/","citationCount":"0","resultStr":"{\"title\":\"Prehospital ECG Interpretation Methods for ST-Elevation MI Detection and Catheterization Laboratory Activation: A Systematic Review and Meta-Analysis.\",\"authors\":\"Ahmad Alrawashdeh, Samar Ihtoub, Zaid I Alkhatib, Mahmoud Alwidyan, Yousef S Khader, Sukaina Rawashdeh, Saeed Alqahtani, Dion Stub, Rahaf Alhamouri, Islam E Alkhazali, Ziad Nehme\",\"doi\":\"10.22037/aaemj.v13i1.2627\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>The diagnostic accuracies of different electrocardiography (ECG) interpretation methods remain unclear. Therefore, this study aimed to systematically evaluate and compare the diagnostic accuracy of prehospital 12-lead ECG interpretation methods for identifying ST-elevation myocardial infarction (STEMI) and activating cardiac catheterization laboratories (CCLs).</p><p><strong>Methods: </strong>A comprehensive search was conducted in Medline, Scopus, and CINAHL databases up to August 2024. Two reviewers independently selected studies that assessed the diagnostic accuracy of prehospital 12-lead ECG in real-time STEMI identification and CCL activation. Pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated using bivariate generalized mixed-effects regression models or random-effects meta-analysis as appropriate. The quality of the included studies was assessed using the QUADAS-2 tool.</p><p><strong>Results: </strong>Thirty-six studies involving 67,168 patients were included. Overall, for STEMI identification, the pooled AUC of ECG was 0.96 (95%CI:0.94-0.98), sensitivity was 80% (95% CI, 69-88%), specificity was 97% (95%CI: 94-98%), and DOR was 114 (95%CI: 59-222). Ambulance clinicians achieved the highest DOR (264; 95%CI: 33-2125), followed by transmission method (136; 95%CI, 59-312) and computer-assisted analysis (78; 95%CI: 33-186). Transmission method demonstrated superior specificity (0.98; 95%CI: 0.94-0.99) and the lowest rates of inappropriate (13.2%; 95% CI: 8.6%-19.2%), and false-positive (11.0%; 95%CI: 6.9%-15.0%) CCL activations.</p><p><strong>Conclusion: </strong>All prehospital ECG interpretation methods yielded acceptable diagnostic accuracy for STEMI identification; however, transmission offered the greatest specificity and fewer unnecessary CCL activations. Adopting transmission-based strategies, where feasible, and enhancing training and decision support for ambulance clinicians may improve prehospital STEMI detection and resource utilization.</p>\",\"PeriodicalId\":8146,\"journal\":{\"name\":\"Archives of Academic Emergency Medicine\",\"volume\":\"13 1\",\"pages\":\"e47\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-05-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145131/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of Academic Emergency Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.22037/aaemj.v13i1.2627\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Academic Emergency Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.22037/aaemj.v13i1.2627","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
Prehospital ECG Interpretation Methods for ST-Elevation MI Detection and Catheterization Laboratory Activation: A Systematic Review and Meta-Analysis.
Introduction: The diagnostic accuracies of different electrocardiography (ECG) interpretation methods remain unclear. Therefore, this study aimed to systematically evaluate and compare the diagnostic accuracy of prehospital 12-lead ECG interpretation methods for identifying ST-elevation myocardial infarction (STEMI) and activating cardiac catheterization laboratories (CCLs).
Methods: A comprehensive search was conducted in Medline, Scopus, and CINAHL databases up to August 2024. Two reviewers independently selected studies that assessed the diagnostic accuracy of prehospital 12-lead ECG in real-time STEMI identification and CCL activation. Pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated using bivariate generalized mixed-effects regression models or random-effects meta-analysis as appropriate. The quality of the included studies was assessed using the QUADAS-2 tool.
Results: Thirty-six studies involving 67,168 patients were included. Overall, for STEMI identification, the pooled AUC of ECG was 0.96 (95%CI:0.94-0.98), sensitivity was 80% (95% CI, 69-88%), specificity was 97% (95%CI: 94-98%), and DOR was 114 (95%CI: 59-222). Ambulance clinicians achieved the highest DOR (264; 95%CI: 33-2125), followed by transmission method (136; 95%CI, 59-312) and computer-assisted analysis (78; 95%CI: 33-186). Transmission method demonstrated superior specificity (0.98; 95%CI: 0.94-0.99) and the lowest rates of inappropriate (13.2%; 95% CI: 8.6%-19.2%), and false-positive (11.0%; 95%CI: 6.9%-15.0%) CCL activations.
Conclusion: All prehospital ECG interpretation methods yielded acceptable diagnostic accuracy for STEMI identification; however, transmission offered the greatest specificity and fewer unnecessary CCL activations. Adopting transmission-based strategies, where feasible, and enhancing training and decision support for ambulance clinicians may improve prehospital STEMI detection and resource utilization.
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