In search of the best method to predict acute coronary syndrome using only the electrocardiogram from the emergency department.

Jakob L Forberg, Michael Green, Jonas Björk, Mattias Ohlsson, Lars Edenbrandt, Hans Öhlin, Ulf Ekelund

Research output: Contribution to journalArticlepeer-review

Abstract

INTRODUCTION: The aim of this study was to compare different methods to predict acute coronary syndrome (ACS) using only data from a single electrocardiogram (ECG) in the emergency department (ED). METHOD: We compared the ACS prediction abilities of classical ECG criteria, human expert ECG interpretation, a logistic regression model and an artificial neural network ensemble (ANN). The ED ECG and discharge diagnoses were retrieved for 861 patient visits to the ED for chest pain. Cross-validation was used to estimate the generalization performance of the logistic regression and the ANN model. RESULTS: The logistic regression model had the overall best performance in predicting ACS with an area under the receiver operating characteristic curve of 0.88. The sensitivities of logistic regression, ANN, expert physicians, and classical ECG criteria were 95%, 95%, 82%, and 75%, respectively, and the specificities were 54%, 44%, 63%, and 69%. CONCLUSION: Our logistic regression model was the best overall method to predict ACS, followed by our ANN. Decision support models have the potential to improve even experienced ECG readers' ability to predict ACS in the ED.
Original languageEnglish
Pages (from-to)58-63
Number of pages6
JournalJournal of Electrocardiology
Volume42
Issue number1
DOIs
Publication statusPublished - 2009

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems

Keywords

  • Neural network ensembles
  • Myocardial infarction
  • Acute coronary syndrome
  • Diagnosis
  • Unstable angina pectoris
  • Electrocardiography

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