September 1, 2006Journal of Telemedicine and Telecare
Validation of 12-lead tele-electrocardiogram transmission in the real-life scenario of acute coronary syndrome
Why the study?
Does 12-lead tele-ECG transmission provide accurate diagnostic agreement with standard 12-lead ECG in patients with acute coronary syndrome?
Population
120 patients referred to hospitals because of acute coronary syndrome (ACS), mean age 64 years
Comparison
12-lead tele-electrocardiogram transmitted to a… vs Standard 12-lead ECG recorded at the same time
Design
Cross-sectional, independently and blindly by two cardiologists and one…
Authors
Discussion
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Implication
Tele-ECG may support remote STEMI diagnosis in ACS; supports feasibility but leaves open prospective outcome trials.
Key Points
- To validate the diagnostic reliability and accuracy of 12-lead electrocardiograms transmitted via telephone compared with standard 12-lead electrocardiograms in patients presenting with acute coronary syndrome.
- Evaluated N=120 patients (mean age 64 years) referred to hospitals due to acute coronary syndrome.
- Recorded standard 12-lead ECGs and simultaneous tele-ECGs transmitted over telephone lines to a centralized call center.
- Conducted independent, blinded diagnostic evaluations of both ECG modalities by two cardiologists and one internist.
- Conduction interval measurements showed high concordance, with reliability coefficients of R=0.91 for PQ, R=0.86 for QRS, and R=0.89 for QT intervals, alongside 99% correct rhythm classifications.
- Ischemic changes, including negative T waves, ST-segment elevation, and ST-segment depression, showed strong diagnostic agreement between modalities (kappa = 0.75 to 0.96).
- Identification of ST-elevation myocardial infarction achieved near-perfect agreement across the three blinded readers, yielding kappa coefficients of 0.96, 0.99, and 0.99.
Structured PICO
Does 12-lead tele-ECG transmission provide accurate diagnostic agreement with standard 12-lead ECG in patients with acute coronary syndrome?
P
Population
120 patients referred to hospitals because of acute coronary syndrome (ACS), mean age 64 years
I
Intervention
12-lead tele-electrocardiogram (tele-ECG) transmitted to a call centre via telephone
C
Comparator
Standard 12-lead ECG recorded at the same time
O
Outcome
Agreement between standard and tele-ECG for conduction times, rhythm analysis, ST-segment changes, and STEMI diagnosissurrogate
12-lead tele-ECG transmission is highly accurate and reliable for detecting acute STEMI compared to standard 12-lead ECG.
Cite This Study
Schwaab et al. (2006) studied this question.