Real-time cardiology overread of the electrocardiogram: where is the value added?

Abstract

Patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) must be evaluated expeditiously. A primary goal of the early evaluation is the identification of significant ST-segment changes, with immediate identification of patients having ST-segment elevation (STE) myocardial infraction (STEMI). Rapid and accurate interpretation of the 12-lead electrocardiogram (ECG) represents an extremely important skill during this early, time-sensitive evaluation. The emergency physician most often is responsible for ECG interpretation at this crucial step in the process of care. The emergency physician must be an expert in the interpretation of the ECG in this and other urgent or emergent ED presentations. A recent investigation published in this edition of the American Journal of Emergency Medicine, “[the] Effects of cardiology review of the ecg in patients with suspected acute coronary syndromes” by Feldman and colleagues [1], explores this important topic of ECG interpretation in the ED—with the addition of a “real-time” secondary review and interpretation of the ECG by a cardiologist. In this project, the authors at an academic medical center performed a prospective observational study investigating the impact of “real-time” cardiology review of the ECG in ED patients suspected of ACS. The review occurred on weekdays, from 8 AM to 11 PM. Of note, ECGs that were interpreted by the emergency physician as “normal” or “unchanged from baseline” (most ED ECGs) were excluded. Emergency