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The accurate interpretation of potential ST-segment elevations on electrocardiograms (ECGs) to diagnose acute myocardial infarction (MI) is a critical competency for emergency physicians (EPs) and cardiologists. There is conflicting evidence on the diagnostic accuracy of EPs and cardiologists interpreting potential STEMI ECGs.  Methods:  We conducted a web-based assessment of the diagnostic accuracy of potential STEMI ECGs of Canadian EPs and cardiologists. They were identified using the membership lists of the Canadian Association of Emergency Physicians and the academic departments of cardiology at Canadian medical schools. When provided with 20 ECGs of confirmed STEMI patients, EPs and cardiologists were asked to provide a binary Yes/No answer to the question, “In a patient with ischemic chest pain, does this ECG represent a STEMI?” EPs and cardiologists were blinded to the correct answers while completing the web-based assessment. Descriptive statistics were used to described frequencies and counts. Analysis using Rasch Measurement Theory was used to explore the relationship between correct interpretation of ECGs and predictive variables such as age, years in practice or type of practice.  Results:  Two hundred and fifty EPs and 30 cardiologists (n=280) responded to our survey (total response rate 25%). Average years in practice were 12.5 for EPs (SD 10.6; median 10) and 14.6 for cardiologists (SD 10.6; median 11); 52% of EPs and 93% of cardiologists practiced in an academic setting. Seven of the cardiologists were interventionalists, while 47.6% of EPs and 97% of cardiologists practiced at hospitals with 24-hour catheterization capability. The diagnostic accuracy of EPs for identifying STEMI ECGs was 75% (SD 15%); cardiologists’ accuracy was 76% (SD 15.5%). The ability to correctly interpret the ECGs was independent of age, years in practice, or type of practice (community vs academic).  Conclusion:  EPs and cardiologists display similar diagnostic accuracy for interpreting STEMI ECGs, regardless of age, years in practice or type of practice. The findings of our study suggest the need for focused ECG education for both EPs and cardiologists.

cjem. canadian journal of emergency medical care/cjem

MP034: What is the diagnostic accuracy of Canadian emergency physicians and cardiologists interpreting potential acute ST-elevation myocardial infarction (STEMI) electrocardiograms?