Test of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) for prehospital use.

Abstract

To test diagnostic performance for acute cardiac ischemia (ACI) in a manually calculated and in a computerized, ECG-calculated ACI time-insensitive predictive instrument (ACI-TIPI) in prehospital chest pain patients. We carried out prospective inclusion and data acquisition with retrospective analysis. Over a 6-month period, 439 adult emergency medical services patients with chest pain underwent prehospital electrocardiography. Because of incomplete data, 77 cases were excluded, leaving a study sample of 362 patients. Excluded patients did not differ significantly with respect to age, sex, final diagnosis, or history of myocardial infarction, heart surgery, diabetes, or stroke. ACI-TIPI probabilities of ACI were computed on the basis of the prehospital ECGs as interpreted retrospectively and independently by two study investigators blinded to patient outcome, with a specially programmed electrocardiograph, and with a computer algorithm further modified by logistic-regression analysis. Diagnostic performance on the basis of receiver operating characteristic (ROC) curve areas of the ACI-TIPI was scored, by the two physician readers, .73 and .74; and by ECG, .75. Patients with low ACI-TIPI probability (0% to 9%) had no acute myocardial infarctions, a 2.3% incidence of angina, and no prehospital life-threatening events. ACI-TIPI probabilities of ACI as generated by a specially programmed electrocardiograph are comparable to those based on physician ECG interpretations and may be useful in the prehospital evaluation of chest pain.