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April 14, 1993

Diagnosis of Myocardial Infarction by Emergency Department Physicians

Author Affiliations

The Bryn Mawr (Pa) Hospital

JAMA. 1993;269(14):1793. doi:10.1001/jama.1993.03500140045032

To the Editor.  —In their article on thrombolytic therapy, Doorey et al1 state that the accuracy of electrocardiographic (ECG) diagnosis has been improved with the official electrocardiographer interpretation compared with that by emergency department physicians (EDPs). They suggest that ECGs be faxed to electrocardiographers for accurate readings in order to increase the number of eligible patients for thrombolytic therapy in the setting of possible acute myocardial infarction (AMI). However, the studies cited do not support such statements. In the study by Lee et al,2 readings by the EDPs were compared with those of electrocardiographers. These were not prospective blinded interpretations. Electrocardiographers had both subsequent clinical course information and evolving ECGs at their disposal. Their readings were more accurate as would be expected with the 20/20 vision of hindsight. The study in no way supports the notion that the accuracy of ECG readings was improved in real time. The