Ahmed Alotaibi
External validation of the Manchester acute coronary syndromes ECG risk model within a pre-hospital setting
Alotaibi, Ahmed; Alghamdi, Abdulrhman; Martin, Glen P; Carlton, Edward; Cooper, Jamie G; Cook, Eloïse; Siriwardena, Aloysius Niroshan; Phillips, John; Thompson, Alexander; Bell, Steve; Kirby, Kim Lucy; Rosser, Andy; Pennington, Elspeth; Body, Richard
Authors
Abdulrhman Alghamdi
Glen P Martin
Edward Carlton
Jamie G Cooper
Eloïse Cook
Aloysius Niroshan Siriwardena
John Phillips
Alexander Thompson
Steve Bell
Kim Lucy Kirby
Andy Rosser
Elspeth Pennington
Richard Body
Abstract
Objectives: The Manchester Acute Coronary Syndromes ECG (MACS-ECG) prediction model calculates a score based on objective ECG measurements to give the probability of a non-ST elevation myocardial infarction (NSTEMI). The model showed good performance in the emergency department (ED), but its accuracy in the pre-hospital setting is unknown. We aimed to externally validate MACS-ECG in the pre-hospital environment. Methods: We undertook a secondary analysis from the Pre-hospital Evaluation of Sensitive Troponin (PRESTO) study, a multi-centre prospective study to validate decision aids in the pre-hospital setting (26 February 2019 to 23 March 2020). Patients with chest pain where the treating paramedic suspected acute coronary syndrome were included. Paramedics collected demographic and historical data and interpreted ECGs contemporaneously (as € normal' or € abnormal'). After completing recruitment, we analysed ECGs to calculate the MACS-ECG score, using both a pre-defined threshold and a novel threshold that optimises sensitivity to differentiate AMI from non-AMI. This was compared with subjective ECG interpretation by paramedics. The diagnosis of AMI was adjudicated by two investigators based on serial troponin testing in hospital. Results: Of 691 participants, 87 had type 1 AMI and 687 had complete data for paramedic ECG interpretation. The MACS-ECG model had a C-index of 0.68 (95% CI: 0.61 to 0.75). At the pre-determined cut-off, MACS-ECG had 2.3% (95% CI: 0.3% to 8.1%) sensitivity, 99.5% (95% CI: 98.6% to 99.9%) specificity, 40.0% (95% CI: 10.2% to 79.3%) positive predictive value (PPV) and 87.6% (87.3% to 88.0%) negative predictive value (NPV). At the optimal threshold for sensitivity, MACS-ECG had 50.6% sensitivity (39.6% to 61.5%), 83.1% specificity (79.9% to 86.0%), 30.1% PPV (24.7% to 36.2%) and 92.1% NPV (90.4% to 93.5%). In comparison, paramedics had a sensitivity of 71.3% (95% CI: 60.8% to 80.5%) with 53.8% (95% CI: 53.8% to 61.8%) specificity, 19.7% (17.2% to 22.45%) PPV and 93.3% (90.8% to 95.1%) NPV. Conclusion: Neither MACS-ECG nor paramedic ECG interpretation had a sufficiently high PPV or NPV to € rule in' or € rule out' NSTEMI alone.
Journal Article Type | Article |
---|---|
Acceptance Date | Mar 29, 2023 |
Online Publication Date | Apr 17, 2023 |
Publication Date | May 23, 2023 |
Deposit Date | May 12, 2023 |
Publicly Available Date | May 12, 2023 |
Journal | Emergency Medicine Journal |
Print ISSN | 1472-0205 |
Electronic ISSN | 1472-0213 |
Publisher | BMJ Publishing Group |
Peer Reviewed | Peer Reviewed |
Volume | 40 |
Pages | 431-436 |
DOI | https://doi.org/10.1136/emermed-2022-212872 |
Keywords | acute myocardial infarct, electrocardiography, emergency ambulance systems, pre-hospital, non-trauma |
Public URL | https://uwe-repository.worktribe.com/output/10746692 |
Publisher URL | https://emj.bmj.com/content/early/2023/04/17/emermed-2022-212872 |
Files
External validation of the Manchester acute coronary syndromes ECG risk model within a pre-hospital setting
(452 Kb)
PDF
Licence
http://creativecommons.org/licenses/by-nc/4.0/
Publisher Licence URL
http://creativecommons.org/licenses/by-nc/4.0/
You might also like
Downloadable Citations
About UWE Bristol Research Repository
Administrator e-mail: repository@uwe.ac.uk
This application uses the following open-source libraries:
SheetJS Community Edition
Apache License Version 2.0 (http://www.apache.org/licenses/)
PDF.js
Apache License Version 2.0 (http://www.apache.org/licenses/)
Font Awesome
SIL OFL 1.1 (http://scripts.sil.org/OFL)
MIT License (http://opensource.org/licenses/mit-license.html)
CC BY 3.0 ( http://creativecommons.org/licenses/by/3.0/)
Powered by Worktribe © 2024
Advanced Search