Abstract 11623: Determination of the Diagnostic Accuracy of a Mobile Smartphone ECG Device Compared to a Standard 12-Lead ECG for Evaluation of ST-Segment Elevation Myocardial Infarction (STEMI). Primary Results of the ST LEUIS International Multicenter Study

Background: Patients with STEMI who receive rapid diagnosis and reperfusion therapy have improved clinical outcomes. The rate-limiting step in STEMI diagnosis is often the availability of a 12-lead electrocardiogram (ECG) and its interpretation. Recent technology has provided a means of obtaining an ECG recording through smartphones equipped with a 2-wire attachment and software that can potentially produce the equivalent of a standard 12-lead ECG. The ST LEUIS study tested whether a smartphone ECG (AliveCor Inc., Mountain View, CA) can accurately diagnose STEMI in patients presenting with chest pain compared to a standard 12-lead ECG. Methods: Consenting subjects presenting with chest pain or STEMI protocol activation had simultaneous recordings performed with a standard 12-lead and a smartphone '12-lead equivalent' ECG. Matched smartphone and standard ECGs were evaluated separately, both quantitatively and qualitatively, by a panel of blinded, experienced readers and were classified as STEMI/LBBB, not-STEMI, or not interpretable. Interpretable ECG pairs also were subjectively graded as showing good, fair, or poor correlation. Results: A total of 204 subjects (age = 60 years, males = 57%, STEMI activation = 45%) were enrolled from 5 international sites (See Table). For all interpretable smartphone ECGs, versus standard ECGs, the sensitivity, specificity, positive, and negative predictive value for STEMI/LBBB were 0.89, 0.84, 0.70 and 0.95, respectively. Qualitative, interpretable paired ECG evaluations showed 152 (79.2%), 32 (16.7%) and 8 (4.2%) pairs with good, fair and poor correlation, respectively. Conclusion: This first-of-its-kind multicenter, international comparison study demonstrates that a 12-lead equivalent ECG obtained using a smartphone, coupled with a software app and an inexpensive 2-wire attachment, can identify STEMI vs not-STEMI with good correlation and high sensitivity compared to a traditional 12-lead ECG. This technology, including further technical refinements, may provide more rapid ECG access to patients presenting in less urban or remote areas, third world nations, or at home (by family members) before first medical contact, thus potentially improving early STEMI diagnosis and care throughout the world. [ABSTRACT FROM AUTHOR]