Abstract
Objective
To implement an all-day artificial intelligence (AI)–based system to facilitate chest
pain triage in the emergency department.
Methods
The AI-based triage system encompasses an AI model combining a convolutional neural
network and long short-term memory to detect ST-elevation myocardial infarction (STEMI)
on electrocardiography (ECG) and a clinical risk score (ASAP) to prioritize patients
for ECG examination. The AI model was developed on 2907 twelve-lead ECGs: 882 STEMI
and 2025 non-STEMI ECGs.
Results
Between November 1, 2019, and October 31, 2020, we enrolled 154 consecutive patients
with STEMI: 68 during the AI-based triage period and 86 during the conventional triage
period. The mean ± SD door-to-balloon (D2B) time was significantly shortened from
64.5±35.3 minutes to 53.2±12.7 minutes (P=.007), with 98.5% vs 87.2% (P=.009) of D2B times being less than 90 minutes in the AI group vs the conventional
group. Among patients with an ASAP score of 3 or higher, the median door-to-ECG time
decreased from 30 minutes (interquartile range [IQR], 7−59 minutes) to 6 minutes (IQR,
4−30 minutes) (P<.001). The overall performances of the AI model in identifying STEMI from 21,035
ECGs assessed by accuracy, precision, recall, area under the receiver operating characteristic
curve, F1 score, and specificity were 0.997, 0.802, 0.977, 0.999, 0.881, and 0.998,
respectively.
Conclusion
Implementation of an all-day AI-based triage system significantly reduced the D2B
time, with a corresponding increase in the percentage of D2B times less than 90 minutes
in the emergency department. This system may help minimize preventable delays in D2B
times for patients with STEMI undergoing primary percutaneous coronary intervention.
Abbreviations and Acronyms:
1D (1-dimensional), AI (artificial intelligence), CAD (coronary artery disease), cath lab (catheterization laboratory), CNN (convolutional neural network), D2B (door-to-balloon), ECG (electrocardiography), ED (emergency department), GRACE (Global Registry of Acute Coronary Events), LSTM (long short-term memory), PPCI (primary percutaneous coronary intervention), STEMI (ST-segment elevation myocardial infarction), TIMI (Thrombolysis in Myocardial Infarction)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: November 03, 2022
Footnotes
Grant Support: This study was supported in part by the Taiwan Ministry of Science and Technology (MOST 110-2314-B-039-050, MOST 109-2314-B-039-045, and MOST 108-2314-B-039-055) and China Medical University Hospital ( DMR-108-013 , DMR-109-012 , and DMR-110-012 ). None of these funding sources had a further role in the study design; the collection, analysis, or interpretation of the data; the writing of the report; or the decision to submit the paper for publication.
Identification
Copyright
© 2022 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
