A man in his early 40s with chest pain a " normal ECG " by computer algorithm. Should we avoid interrupting a physician to interpret his ECG?

This study looked at less than 1000 cases, which is not nearly enough (see below for analysis) and they used cardiologists as the gold standard (a very poor gold standard), NOT presence or absence of Occlusion MI (which we have done in all of our ECG studies, and must be ascertained by 1) TIMI 0/2 flow on angiogram or 2) culprit + TIMI 3 flow and very high troponin. So this study is worthless and must be ignored. I have here 38 cases of " Computer Normal " ECGs which were critically abnormal and the vast majority are missed acute coronary occlusions (Missed Acute OMI) and most were recognized by the physician.We wrote this Editorial in the Journal of Electrocardiology in 2019.  Litell JM, Meyers HP, Smith SW. Emergency physicians should be shown all triage ECGs, even those with a computer interpretation of “Normal.” J Electrocardiol [Internet] 2019;54:79–81. Available from: http://dx.doi.org/10.1016/j.jelectrocard.2019.03.003Excerpt:" To illustrate the limitations imposed by sample size, recent data from our institution reveal that we identify approximately 225 type I myocardial infarctions (MI) in a typical year. These include about 60 occlusion MI (OMI) with clear ST segment elevation (none of which would be called “Normal” by the computer) and about 165 Non-STEMI. Of the Non-STEMI in our cohort, about 25% will actually have acute coronary occlusion.  While most of these roughly 40 NSTEMI occlusions would be read by the...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs