Key result
Prehospital 12-lead ECG interpretation methods yielded high diagnostic accuracy for STEMI identification (pooled AUC 0.96), with transmission offering the greatest specificity and fewest unnecessary catheterization laboratory activations.
Why the study?
The diagnostic accuracies of different ECG interpretation methods for identifying STEMI and activating cardiac catheterization laboratories remain unclear.
What is the diagnostic accuracy of different prehospital 12-lead ECG interpretation methods for identifying STEMI and activating cardiac catheterization laboratories?
Meta-Analysis (n=67,168)
What is the diagnostic accuracy of different prehospital 12-lead ECG interpretation methods for identifying STEMI and activating cardiac catheterization laboratories?
Odds Ratio: 114 (95% CI 59–222)
All prehospital ECG interpretation methods have acceptable diagnostic accuracy for STEMI, but transmission-based strategies offer the greatest specificity and reduce unnecessary catheterization laboratory activations.
Favor transmission-based prehospital ECGs to minimize inappropriate CCL activations; reinforces high diagnostic accuracy across STEMI interpretation methods.
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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Alrawashdeh et al. (2025) conducted a meta-analysis in Suspected ST-elevation myocardial infarction (STEMI) (n=67,168). Prehospital 12-lead ECG interpretation methods vs. Reference standard (final hospital diagnosis, cardiologist/emergency physician interpretation, or angiography findings) was evaluated on Diagnostic accuracy for STEMI identification (DOR 114, 95% CI 59-222). Prehospital 12-lead ECG interpretation methods yielded high diagnostic accuracy for STEMI identification (pooled AUC 0.96), with transmission offering the greatest specificity and fewest unnecessary catheterization laboratory activations.
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