Electrocardiographic ST-segment elevation myocardial infarction in critically ill patients: An observational cohort analysis

OBJECTIVE:To investigate the specificity of the electrocardiographic diagnosis of ST-segment elevation myocardial infarction in the critical care unit setting. DESIGN:Retrospective observational cohort analysis. SETTING:An 880-bed tertiary care teaching hospital with 120 intensive care unit beds. PATIENTS:The population included medical, surgical, trauma, and neurosurgical intensive care unit patients. INTERVENTIONS:Electrocardiograms were systematically collected to include all consecutive recordings over a 15-month period in which the interpretation software indicated ***ACUTE MI***. Patient demographics, markers of intensive care unit complexity, and hospital mortality were ascertained. The electrocardiograms were then further evaluated by a blinded, board-certified cardiologist for agreement or disagreement with the interpretation software. Serum troponin measurements obtained within 96 hrs of electrocardiogram acquisition were used to determine the likelihood of myocardial infarction. MEASUREMENTS AND MAIN RESULTS:Over the 15-month study period, the interpretation software diagnosed ST-segment elevation myocardial infarction in 67 of 2243 intensive care unit patients (2.99%) who had an electrocardiogram performed. In the final study population of 46 cases with electrocardiographic ST-segment elevation myocardial infarction, 85% had peak troponin elevation