Performance of Artificial Intelligence–Powered ECG Analysis in Suspected ST-Segment Elevation Myocardial Infarction

作者：Scott W. Sharkey, Robert Herman, Dawn Witt, Frank Aguirre, Mehmet Yildiz, David M. Larson, Avinash Murthy, Heather Rohm, Stephen W. Smith, Will Belzer, Jenny Chambers, Ellen Cravero, Seth Bergstedt, Greg Kerola, David Farmer, Andrew Willett, H. Pendell Meyers, Julia Harris, Christopher M VanHove, Timothy D. Henry · 发表于：JACC Advances · 年份：2026 · DOI：10.1016/j.jacadv.2026.102671 · 被引用次数：2 · 研究领域：ECG Monitoring and Analysis、Cardiac electrophysiology and arrhythmias、Atrial Fibrillation Management and Outcomes

BACKGROUND: Artificial intelligence (AI)-based electrocardiogram (ECG) analysis has emerged as a promising adjunct to human ECG interpretation in suspected ST-segment elevation myocardial infarction (STEMI). OBJECTIVES: To expand knowledge in this evolving field, the authors retrospectively analyzed the performance of a novel AI-ECG model in patients with cardiac catheterization laboratory activation for suspected STEMI. METHODS: Consecutive patients were gathered from a multicenter U.S. STEMI registry (2018-2022) and categorized into 3 clinical cohorts based on the presence or absence of angiographic culprit and troponin elevation: acute myocardial infarction (AMI) with culprit, AMI without culprit, and no-AMI. Cardiac catheterization laboratory-activating ECGs were analyzed using an AI-ECG model trained to identify acute coronary occlusion and classified as occlusion myocardial infarction, OMI(+) or not, OMI(-). RESULTS: The study included 2,523 patients, 68.3% male, with a median age of 63 years. AMI with culprit was present in 2076 (82.3%), AMI without culprit in 314 (12.4%), and no-AMI in 133 (5.3%). Among AMI with culprit patients, the model correctly identified 93.8% as OMI(+). Sensitivity for TIMI flow 0/1, 2, and 3 was 96.3%, 93.1%, and 86.9% respectively; P < 0.001. The model correctly identified 79.7% of no-AMI patients as OMI(-). The AUCROC was 0.952 (95% CI: 0.924-0.966). The AMI without culprit cohort included takotsubo syndrome OMI(+) = 78%, MI with nonobstruct...