Agreement between cardiologists and fellows in interpretation of ischemic electrocardiographic changes in acute myocardial infarction

Abstract

BackgroundTime from symptom onset may not be the best indicator for choosing reperfusion therapy for patients presenting with acute ST-elevation myocardial infarction (STEMI); consequently ECG-based methods have been developed. MethodsThis study evaluated the inter-observer agreement between experienced cardiologists and junior doctors in identifying the ECG findings of the pre-infarction syndrome (PIS) and evolving myocardial infarction (EMI). The ECGs of 353 STEMI patients were independently analyzed by two cardiologists, one fellow in cardiology, one fellow in internal medicine and a medical student. The last two were given a half-hour introduction of the PIS/EMI-algorithm. ResultsThe inter-observer reliability between all the investigators was found to be good according to kappa statistics (κ 0.632–0.790) for the whole study population. When divided into different subgroups, the inter-observer agreements were from good to very good between the cardiologists and the fellow in cardiology (κ 0.652 –0.813) and from moderate to good (κ 0.464–0.784) between the fellow in internal medicine, medical student and the others. ConclusionsThe PIS and EMI ECG patterns are reliably identified by experienced cardiologists and can be easily adopted by junior doctors.