School of Medicine and Health Sciences Poster Presentations

Title

Optimizing Electrocardiogram Interpretation and Catheterization Laboratory Activation in ST-Segment Elevation Myocardial Infarct

Poster Number

215

Document Type

Poster

Publication Date

3-2016

Abstract

Background: To achieve the 90-minute reperfusion goal in ST-segment elevation myocardial infarction (STEMI) care, providers must diagnose STEMIs from electrocardiograms (ECGs) obtained upon emergency room arrival and appropriately activate the catheterization lab. To enhance early STEMI care, we sought to improve medical student STEMI recognition and diagnostic accuracy with a teaching module we designed and developed.

Methods: Through a literature review, we identified evidenced-based criteria for classic STEMI patterns, STEMI-equivalents with non-classic STEMI patterns including hyperacute T-waves, STEMI with existing left bundle branch block (LBBB) and Wellens’ syndrome and non-ischemic STEMI-mimics such as known LBBB, pericarditis, ventricular aneurysm, pulmonary embolism, left ventricular hypertrophy, hyperkalemia, Brugada syndrome, early repolarization and takotsubo cardiomyopathy. We reviewed cases from George Washington University Hospital and compiled the 24 best ECGs with clinical information, diagnostic ECG criteria and imaging including cardiac catheterization, echocardiography and computed tomography into the teaching module. We then conducted a prospective education validation trial with fourth-year medical students. We administered pre- and post-tests comprised of exemplary cases of STEMIs, STEMI-equivalents and STEMI-mimics from our case review. Participants studied the module for two weeks and received a didactic module-based lecture prior to the post-test. Students served as their own control. The primary end point was STEMI recognition, measured by appropriate catheterization lab activation. The secondary endpoint was correct ECG diagnosis. Paired t-tests were used to compare pre- and post-training scores.

Results: Appropriate catheterization lab activation mean score was 61% (SD 0.14) and improved to 76% on post-test (SD 0.18, p<0.0001). Accurate ECG diagnosis mean score was 59% (SD 0.14) and improved to 74% on post-test (SD 0.16, p<0.0001). A sample size of 26 achieved more than 99% power.

Conclusions: The module significantly improved student STEMI recognition, appropriate catheterization lab activation and diagnostic accuracy.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Presented at: GW Research Days 2016

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Optimizing Electrocardiogram Interpretation and Catheterization Laboratory Activation in ST-Segment Elevation Myocardial Infarct

Background: To achieve the 90-minute reperfusion goal in ST-segment elevation myocardial infarction (STEMI) care, providers must diagnose STEMIs from electrocardiograms (ECGs) obtained upon emergency room arrival and appropriately activate the catheterization lab. To enhance early STEMI care, we sought to improve medical student STEMI recognition and diagnostic accuracy with a teaching module we designed and developed.

Methods: Through a literature review, we identified evidenced-based criteria for classic STEMI patterns, STEMI-equivalents with non-classic STEMI patterns including hyperacute T-waves, STEMI with existing left bundle branch block (LBBB) and Wellens’ syndrome and non-ischemic STEMI-mimics such as known LBBB, pericarditis, ventricular aneurysm, pulmonary embolism, left ventricular hypertrophy, hyperkalemia, Brugada syndrome, early repolarization and takotsubo cardiomyopathy. We reviewed cases from George Washington University Hospital and compiled the 24 best ECGs with clinical information, diagnostic ECG criteria and imaging including cardiac catheterization, echocardiography and computed tomography into the teaching module. We then conducted a prospective education validation trial with fourth-year medical students. We administered pre- and post-tests comprised of exemplary cases of STEMIs, STEMI-equivalents and STEMI-mimics from our case review. Participants studied the module for two weeks and received a didactic module-based lecture prior to the post-test. Students served as their own control. The primary end point was STEMI recognition, measured by appropriate catheterization lab activation. The secondary endpoint was correct ECG diagnosis. Paired t-tests were used to compare pre- and post-training scores.

Results: Appropriate catheterization lab activation mean score was 61% (SD 0.14) and improved to 76% on post-test (SD 0.18, p<0.0001). Accurate ECG diagnosis mean score was 59% (SD 0.14) and improved to 74% on post-test (SD 0.16, p<0.0001). A sample size of 26 achieved more than 99% power.

Conclusions: The module significantly improved student STEMI recognition, appropriate catheterization lab activation and diagnostic accuracy.