Comparative accuracy of manual versus computerized electrocardiographic measurement of J-, ST- and T-wave deviations in patients with acute coronary syndrome

Accurate and rapid electrocardiographic interpretation is of crucial importance in acute coronary syndrome (ACS). Computerized electrocardiographic algorithms are often used in out-of-hospital settings. Their accuracy should be carefully validated in ACS, particularly in ST-elevation myocardial infarction. This study evaluated the comparative accuracy of lead-specific computer-based versus manual measurements of the J-point, ST-segment, and T-wave deviations in standard 12-lead electrocardiograms (ECGs) (excluding lead aVR). Sixty-nine consecutive patients with suspected ACS were included. The interobserver reliability in the determination of ST-segment deviation >= 0.2 mV in leads V-2 and V-3 was very good (kappa = 0.94 and 0.93, respectively). Agreement between a cardiologist and the computer regarding ST elevation >= 0.2 mV in lead V-2 was moderate (kappa = 0.72) and in V-3 was very good (kappa = 0.85). For ST depression or elevation >= 0.05 mV in lead LIII, agreement was good and moderate (kappa = 0.79 and 0.51, respectively). Bland-Altman analysis demonstrated clinically acceptable limits of agreement comparing measurements of the J point and the T wave, but clinically inadequate limits of agreement with respect to ST-segment deviation, between the electrocardiographer and the computer. The optimal cut-off points were 0.115 mV (sensitivity 89%, specificity 98%) for the computer program to detect ST elevation >= 0.2 mV and 0.045 mV (sensitivity 74%, specificity 99%) for revealing ST elevation >= 0.1 mV. It was found that automatically measured ST-segment deviations were smaller than those manually measured. In conclusion, a correction should be performed to obtain optimal results in the automated analysis of ECGs, because the results have important implications for clinical decision making. (c) 2005 Elsevier Inc. All rights reserved.