AI-Enabled ECG Analysis Improves Diagnostic Accuracy and Reduces False STEMI Activations

作者：Robert Herman, Bryn E. Mumma, Jake D. Hoyne, Benjamin L. Cooper, Nils P. Johnson, Timea Kisova, Anthony Demolder, Adam Rafajdus, Andrej Iring, Timotej Palus, Marta Belmonte, Emanuele Barbato, Suzanne J. Baron, Róbert Hatala, Stephen W. Smith, H. Pendell Meyers, Scott W. Sharkey, Jozef Bartunek, Timothy D. Henry · 发表于：JACC: Cardiovascular Interventions · 年份：2025 · DOI：10.1016/j.jcin.2025.10.018 · 被引用次数：21 · 研究领域：ECG Monitoring and Analysis、Acute Myocardial Infarction Research、Artificial Intelligence in Healthcare and Education

BACKGROUND: Timely reperfusion is critical in reducing mortality in ST-segment elevation myocardial infarction (STEMI). Although electrocardiography-guided cardiac catheterization laboratory (CCL) activation on the basis of first medical contact recognition improves system-level response, diagnostic uncertainty, particularly in atypical presentations, contributes to false positive activations (FPAs) and reperfusion delays. OBJECTIVES: The aim of this study was to evaluate the diagnostic performance and operational impact of artificial intelligence (AI)-based electrocardiographic (ECG) analysis in real-world STEMI triage across a multicenter U.S. registry. METHODS: A total of 1,032 patients with suspected STEMI who triggered emergent CCL activation at 3 geographically diverse percutaneous coronary intervention centers (January 2020 to May 2024) were retrospectively analyzed. Index electrocardiograms underwent standard triage and blinded retrospective AI ECG analysis (Queen of Hearts, PMcardio) trained to detect acute coronary occlusion and benign mimics. The reference standard was an angiographically confirmed culprit lesion with positive enzymes. Diagnostic accuracy, subgroup analyses, and FPA reclassification were compared. RESULTS: Of 1,032 emergent CCL activations, 601 (58.2%) had confirmed STEMI. The AI ECG model outperformed standard triage, demonstrating higher index ECG sensitivity (553 of 601 [92.0%; 95% CI: 89.7%-94.1%] vs 427 of 601 [71.0%; 95% CI: 67.4%-74.6%]), re...