An artificial neural network to safely reduce the number of ambulance ECGs transmitted for physician assessment in a system with prehospital detection of ST elevation myocardial infarction
BACKGROUND The 12-lead ECG, together with patient history and clinical findings, remains the most important method for early diagnosis of acute myocardial infarction. Automated interpretation of ECG is widely used as decision support for less experienced physicians. Recent reports have demonstrated that artificial neural networks can be used to improve selected aspects of conventional rule-based interpretation programs. The purpose of this study was to detect acute myocardial infarction in the 12-lead ECG with artificial neural networks. METHODS AND RESULTS A total of 1120 ECGs from patients with acute myocardial infarction and 10,452 control ECGs, recorded at an emergency department with computerized ECGs, were studied. Artificial neural networks were trained to detect acute myocardial infarction by use of measurements from the 12 ST-T segments of each ECG, together with the correct diagnosis. After this training process, the performance of the neural networks was compared with that of a widely used ECG interpretation program and the classification of an experienced cardiologist. The neural networks showed higher sensitivities and discriminant power than both the interpretation program and cardiologist. The sensitivity of the neural networks was 15.5% (95% confidence interval [CI], 12.4 to 18.6) higher than that of the interpretation program compared at a specificity of 95.4% (P<.00001) and 10.5% (95% CI, 7.2 to 13.6) higher than the cardiologist at a specificity of 86.3% (P<.00001). CONCLUSIONS Artificial neural networks can be used to improve automated ECG interpretation for acute myocardial infarction. The networks may be useful as decision support even for the experienced ECG readers.