Comparison of an automated thrombolytic predictive instrument to both diagnostic software and an expert cardiologist for diagnosis of an ST elevationacute myocardial infarction

Because the electrocardiograms (ECGs) of patients with symptoms suggesting an acute thrombotic coronary occlusion are typically read by physicians rel atively inexperienced in this skill, it is important to develop automated d ecision support. A Thrombolytic Predictive Instrument (TPI) is now availabl e along with the standard diagnostic software in a commercially available e lectrocardiograph. This study evaluates the performance of the predictive s oftware in comparison to both an expert cardiologist and standard diagnosti c software. True sensitivity and specificity cannot be determined because a cute coronary angiography was not performed. The specificities determined b y this study were excellent (98% and 99%), and the sensitivities were very good (72% and 78%). These results that the TPI will be only rarely applied to patients who do not indeed have an acute coronary thrombosis. However, t he reasons for even this small number of presumably falsely TPI positive pa tients should be determined and analyzed. It is unlikely that alterations o f the thresholds for TPI activation will significantly improve on this very good level of sensitivity, without prohibitively decreasing specificity.