Inter-Rater Reliability of ST-Segment Measurement at a University Hospital in Argentina
American Journal of Internal Medicine
Volume 7, Issue 1, January 2019, Pages: 5-8
Received: Dec. 14, 2018;
Accepted: Jan. 15, 2019;
Published: Jan. 31, 2019
Views 704 Downloads 100
Ignacio Martín Santarelli, Department of Medicine, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
Diego Costa, Cardiovascular Intensive Care Unit, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
Sandra Swieszkowski, Cardiovascular Intensive Care Unit, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
Ricardo Perez de La Hoz, Cardiovascular Intensive Care Unit, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
Follow on us
The accurate determination of the electrocardiographic ST-segment elevation in a patient with clinical suspicion of acute coronary syndrome is essential for treatment with urgent myocardial reperfusion. The aim of this study was to determine the inter-rater reliability of ischemic and non-ischemic ST-segment elevation measurement among physicians with different specialties and experience. We performed an observational, cross-sectional study, with a comparative correlation and paired sampling. 56 physicians from a university hospital in Buenos Aires city were included: Cardiologists from the Coronary Care Unit (CCU) and Cardiology Division, Internal Medicine physicians from the hospitalization, ambulatory care and Emergency divisions, and third- and fourth-year Internal Medicine residents. Each participant analyzed 6 electrocardiograms and was asked to determine the magnitude of the ST-segment elevation at the J-point, and the corresponding diagnosis. The inter-rater coefficient was lower than 0.2, and the global kappa coefficient was 0.06 (p < 0.001). The global correct interpretations were: inferior wall myocardial infarction (MI): 89.3%; anterior wall MI: 51.8%; lateral wall MI: 75%; left bundle branch block: 91.1%; left ventricle hypertrophy: 44.6%; acute pericarditis: 25%. We believe that the low correlation was probably due to the difficulty in determining the J-point. These findings could suggest the need to strengthen the electrocardiographic concepts of ischemia, and the differentiation between ischemic and non-ischemic ST-segment elevations.
J Point, Electrocardiogram, Ischemia, Infarct, ST Segment
To cite this article
Ignacio Martín Santarelli,
Ricardo Perez de La Hoz,
Inter-Rater Reliability of ST-Segment Measurement at a University Hospital in Argentina, American Journal of Internal Medicine.
Vol. 7, No. 1,
2019, pp. 5-8.
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Thygesen K, Alpert JS, Jaffe AS, et al.; Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018 Nov 13; 138 (20): e618-e651.
O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 61: 485-510.
Lim HC, Salandanan EA, Phillips R, Tan JG, Hezan MA. Inter-rater reliability of J-point location and measurement of the magnitude of ST segment elevation at the J-point on ECGs of STEMI patients by emergency department doctors. Emerg Med J 2015 Jan 23. pii: emermed-2014-204102. doi: 10.1136/emermed-2014-204102. [Epub ahead of print].
Koren G, Weiss AT, Hasin Y, et al. Prevention of Myocardial Damage in Acute Myocardial Ischemia by Early Treatment with Intravenous Streptokinase. N Engl J Med 1985; 313: 1384-9.
Verstraete M, Bernard R, Bory M, et al. Randomised trial of intravenous recombinant tissue-type plasminogen activator versus intravenous streptokinase in acute myocardial infarction. Report from the European Cooperative Study Group for Recombinant Tissue-type Plasminogen Activator. Lancet 1985; 1: 842-7.
Erling BF, Perron AD, Brady WJ. Disagreement in the interpretation of electrocardiographic ST segment elevation: a source of error for emergency physicians? Am J Emerg Med 2004; 22: 65-70.
Tanguay A, Lebon J, Brassard E, et al. Diagnostic accuracy of prehospital electrocardiograms interpreted remotely by emergency physicians in myocardial infarction patients. Am J Emerg Med. 2018 Sep 6. pii: S0735-6757 (18)30741-1.
Man S, Ter Haar CC, de Jongh MC, et al. Position of ST-deviation measurements relative to the J-point: Impact for ischemia detection. J Electrocardiol. 2017 Jan - Feb; 50 (1): 82-89.
Multidisciplinary Standardized Reporting Criteria Task Force, Hollander, J. E., Blomkalns, A. L., et al. Standardized reporting guidelines for studies evaluating risk stratification of emergency department patients with potential acute coronary syndromes. Acad Emerg Med. 2004 Dec; 11 (12): 1331-40.
Smith SW. ST segment elevation differs depending on the method of measurement. Acad Emerg Med 2006; 13: 406-12.
Tandberg D, Kastendieck KD, Meskin S. Observer variation in measured ST-segment elevation. Ann Emerg Med 1999; 34: 448-52.
McCabe, JM, Armstrong, EJ, Ku, I., et al. Physician Accuracy in Interpreting Potential ST-Segment Elevation Myocardial Infarction Electrocardiograms. J Am Heart Assoc. 2013 Oct 4; 2 (5): e000268.
Veronese G, Germini F, Ingrassia S, et al. Emergency physician accuracy in interpreting electrocardiograms with potential ST-segment elevation myocardial infarction: Is it enough? Acute Card Care. 2016 Mar; 18 (1): 7-10.
Brady WJ, Perron A, Ullman E. Errors in emergency physician interpretation of ST-segment elevation in emergency department chest pain patients. Acad Emerg Med 2000; 7: 1256-60.
Turnipseed SD, Bair AE, Kirk JD, Diercks DB, Tabar P, Amsterdam EA. Electrocardiogram Differentiation of Benign Early Repolarization Versus Acute Myocardial Infarction by Emergency Physicians and Cardiologists. Acad Emerg Med. 2006 Sep; 13 (9): 961-6.