Interobserver agreement in the electrocardiographic diagnosis of acute myocardial infarction in patients with left bundle branch block

Peter E. Sokolove, Elena B. Sgarbossa, Ezra A Amsterdam, Rebecca Gelber, Thomas C. Lee, Charles Maynard, John R Richards, Richard Valente, Galen S. Wagner

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Study objective: To determine the interobserver agreement between cardiologists and emergency physicians in the ECG diagnosis of acute myocardial infarction (AMI) in patients with left bundle branch block (LBBB) using the ECG algorithm previously described by Sgarbossa et al. Methods: Using the Sgarbossa ECG algorithm, 4 cardiologists and 4 emergency physicians independently interpreted a test set of 224 ECGs with LBBB, of which 100 ECGs were from patients with an evolving AMI. A subset of 25 ECGs was reinterpreted by each reader to test intraobserver agreement for AMI as well as interobserver agreement for the degree of ST-segment deviation. Agreement rates for AMI were estimated using the κ statistic. In addition, the sensitivity and specificity for diagnosing AMI were determined for each reader, using the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO I) enzyme criteria for AMI as the gold standard. The study was conducted at 3 university-affiliated medical centers. The test set contained ECGs from 100 patients enrolled in the GUSTO I trial with LBBB on their initial ECG and an evolving AMI confirmed by serum cardiac enzyme changes, and 124 control patients from the Duke Databank for Cardiovascular Disease who had stable, angiographically documented coronary artery disease and LBBB. Results: There was excellent interobserver agreement (κ=0.81, 95% confidence interval [Cl] 0.80 to 0.83) between cardiologists and emergency physicians for diagnosing AMI. Intraobserver agreement κ values for AMI diagnosis by cardiologists and emergency physicians were 0.81 (95% Cl 0.67 to 0.94) and 0.71 (95% Cl 0.54 to 0.89). The median sensitivity for diagnosing AMI by cardiologists and emergency physicians was 73% (range 66% to 80%) versus 67% (range 61% to 75%); median specificity was 98% (range 97% to 99%) versus 99% (range 98% to 99%). Spearman rank correlation coefficients for the degree of ST-segment deviation in all 12 leads was 0.86 (95% Cl 0.85 to 0.87) among all readers. Conclusion: There is excellent interobserver agreement between cardiologists and emergency physicians for diagnosing AMI when applying the Sgarbossa ECG algorithm to patients with LBBB. Emergency physicians should be able to reliably use this algorithm when evaluating patients.

Original languageEnglish (US)
Pages (from-to)566-571
Number of pages6
JournalAnnals of Emergency Medicine
Volume36
Issue number6
StatePublished - 2000

Fingerprint

Bundle-Branch Block
Myocardial Infarction
Electrocardiography
Emergencies
Physicians
Streptokinase
Tissue Plasminogen Activator
Enzymes
Nonparametric Statistics
Cardiologists
Coronary Artery Disease
Coronary Vessels
Cardiovascular Diseases
Databases
Confidence Intervals

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Interobserver agreement in the electrocardiographic diagnosis of acute myocardial infarction in patients with left bundle branch block. / Sokolove, Peter E.; Sgarbossa, Elena B.; Amsterdam, Ezra A; Gelber, Rebecca; Lee, Thomas C.; Maynard, Charles; Richards, John R; Valente, Richard; Wagner, Galen S.

In: Annals of Emergency Medicine, Vol. 36, No. 6, 2000, p. 566-571.

Research output: Contribution to journalArticle

Sokolove, Peter E. ; Sgarbossa, Elena B. ; Amsterdam, Ezra A ; Gelber, Rebecca ; Lee, Thomas C. ; Maynard, Charles ; Richards, John R ; Valente, Richard ; Wagner, Galen S. / Interobserver agreement in the electrocardiographic diagnosis of acute myocardial infarction in patients with left bundle branch block. In: Annals of Emergency Medicine. 2000 ; Vol. 36, No. 6. pp. 566-571.
@article{f19a72e4e7674890bd8258a2a25dde11,
title = "Interobserver agreement in the electrocardiographic diagnosis of acute myocardial infarction in patients with left bundle branch block",
abstract = "Study objective: To determine the interobserver agreement between cardiologists and emergency physicians in the ECG diagnosis of acute myocardial infarction (AMI) in patients with left bundle branch block (LBBB) using the ECG algorithm previously described by Sgarbossa et al. Methods: Using the Sgarbossa ECG algorithm, 4 cardiologists and 4 emergency physicians independently interpreted a test set of 224 ECGs with LBBB, of which 100 ECGs were from patients with an evolving AMI. A subset of 25 ECGs was reinterpreted by each reader to test intraobserver agreement for AMI as well as interobserver agreement for the degree of ST-segment deviation. Agreement rates for AMI were estimated using the κ statistic. In addition, the sensitivity and specificity for diagnosing AMI were determined for each reader, using the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO I) enzyme criteria for AMI as the gold standard. The study was conducted at 3 university-affiliated medical centers. The test set contained ECGs from 100 patients enrolled in the GUSTO I trial with LBBB on their initial ECG and an evolving AMI confirmed by serum cardiac enzyme changes, and 124 control patients from the Duke Databank for Cardiovascular Disease who had stable, angiographically documented coronary artery disease and LBBB. Results: There was excellent interobserver agreement (κ=0.81, 95{\%} confidence interval [Cl] 0.80 to 0.83) between cardiologists and emergency physicians for diagnosing AMI. Intraobserver agreement κ values for AMI diagnosis by cardiologists and emergency physicians were 0.81 (95{\%} Cl 0.67 to 0.94) and 0.71 (95{\%} Cl 0.54 to 0.89). The median sensitivity for diagnosing AMI by cardiologists and emergency physicians was 73{\%} (range 66{\%} to 80{\%}) versus 67{\%} (range 61{\%} to 75{\%}); median specificity was 98{\%} (range 97{\%} to 99{\%}) versus 99{\%} (range 98{\%} to 99{\%}). Spearman rank correlation coefficients for the degree of ST-segment deviation in all 12 leads was 0.86 (95{\%} Cl 0.85 to 0.87) among all readers. Conclusion: There is excellent interobserver agreement between cardiologists and emergency physicians for diagnosing AMI when applying the Sgarbossa ECG algorithm to patients with LBBB. Emergency physicians should be able to reliably use this algorithm when evaluating patients.",
author = "Sokolove, {Peter E.} and Sgarbossa, {Elena B.} and Amsterdam, {Ezra A} and Rebecca Gelber and Lee, {Thomas C.} and Charles Maynard and Richards, {John R} and Richard Valente and Wagner, {Galen S.}",
year = "2000",
language = "English (US)",
volume = "36",
pages = "566--571",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Interobserver agreement in the electrocardiographic diagnosis of acute myocardial infarction in patients with left bundle branch block

AU - Sokolove, Peter E.

AU - Sgarbossa, Elena B.

AU - Amsterdam, Ezra A

AU - Gelber, Rebecca

AU - Lee, Thomas C.

AU - Maynard, Charles

AU - Richards, John R

AU - Valente, Richard

AU - Wagner, Galen S.

PY - 2000

Y1 - 2000

N2 - Study objective: To determine the interobserver agreement between cardiologists and emergency physicians in the ECG diagnosis of acute myocardial infarction (AMI) in patients with left bundle branch block (LBBB) using the ECG algorithm previously described by Sgarbossa et al. Methods: Using the Sgarbossa ECG algorithm, 4 cardiologists and 4 emergency physicians independently interpreted a test set of 224 ECGs with LBBB, of which 100 ECGs were from patients with an evolving AMI. A subset of 25 ECGs was reinterpreted by each reader to test intraobserver agreement for AMI as well as interobserver agreement for the degree of ST-segment deviation. Agreement rates for AMI were estimated using the κ statistic. In addition, the sensitivity and specificity for diagnosing AMI were determined for each reader, using the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO I) enzyme criteria for AMI as the gold standard. The study was conducted at 3 university-affiliated medical centers. The test set contained ECGs from 100 patients enrolled in the GUSTO I trial with LBBB on their initial ECG and an evolving AMI confirmed by serum cardiac enzyme changes, and 124 control patients from the Duke Databank for Cardiovascular Disease who had stable, angiographically documented coronary artery disease and LBBB. Results: There was excellent interobserver agreement (κ=0.81, 95% confidence interval [Cl] 0.80 to 0.83) between cardiologists and emergency physicians for diagnosing AMI. Intraobserver agreement κ values for AMI diagnosis by cardiologists and emergency physicians were 0.81 (95% Cl 0.67 to 0.94) and 0.71 (95% Cl 0.54 to 0.89). The median sensitivity for diagnosing AMI by cardiologists and emergency physicians was 73% (range 66% to 80%) versus 67% (range 61% to 75%); median specificity was 98% (range 97% to 99%) versus 99% (range 98% to 99%). Spearman rank correlation coefficients for the degree of ST-segment deviation in all 12 leads was 0.86 (95% Cl 0.85 to 0.87) among all readers. Conclusion: There is excellent interobserver agreement between cardiologists and emergency physicians for diagnosing AMI when applying the Sgarbossa ECG algorithm to patients with LBBB. Emergency physicians should be able to reliably use this algorithm when evaluating patients.

AB - Study objective: To determine the interobserver agreement between cardiologists and emergency physicians in the ECG diagnosis of acute myocardial infarction (AMI) in patients with left bundle branch block (LBBB) using the ECG algorithm previously described by Sgarbossa et al. Methods: Using the Sgarbossa ECG algorithm, 4 cardiologists and 4 emergency physicians independently interpreted a test set of 224 ECGs with LBBB, of which 100 ECGs were from patients with an evolving AMI. A subset of 25 ECGs was reinterpreted by each reader to test intraobserver agreement for AMI as well as interobserver agreement for the degree of ST-segment deviation. Agreement rates for AMI were estimated using the κ statistic. In addition, the sensitivity and specificity for diagnosing AMI were determined for each reader, using the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO I) enzyme criteria for AMI as the gold standard. The study was conducted at 3 university-affiliated medical centers. The test set contained ECGs from 100 patients enrolled in the GUSTO I trial with LBBB on their initial ECG and an evolving AMI confirmed by serum cardiac enzyme changes, and 124 control patients from the Duke Databank for Cardiovascular Disease who had stable, angiographically documented coronary artery disease and LBBB. Results: There was excellent interobserver agreement (κ=0.81, 95% confidence interval [Cl] 0.80 to 0.83) between cardiologists and emergency physicians for diagnosing AMI. Intraobserver agreement κ values for AMI diagnosis by cardiologists and emergency physicians were 0.81 (95% Cl 0.67 to 0.94) and 0.71 (95% Cl 0.54 to 0.89). The median sensitivity for diagnosing AMI by cardiologists and emergency physicians was 73% (range 66% to 80%) versus 67% (range 61% to 75%); median specificity was 98% (range 97% to 99%) versus 99% (range 98% to 99%). Spearman rank correlation coefficients for the degree of ST-segment deviation in all 12 leads was 0.86 (95% Cl 0.85 to 0.87) among all readers. Conclusion: There is excellent interobserver agreement between cardiologists and emergency physicians for diagnosing AMI when applying the Sgarbossa ECG algorithm to patients with LBBB. Emergency physicians should be able to reliably use this algorithm when evaluating patients.

UR - http://www.scopus.com/inward/record.url?scp=0033668072&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033668072&partnerID=8YFLogxK

M3 - Article

C2 - 11097696

AN - SCOPUS:0033668072

VL - 36

SP - 566

EP - 571

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 6

ER -