Prospective Validation of AI-Powered ECG Interpretation Assisting Cathlab Activation in a Smartphone-Based STEMI Network
Overview
This prospective study implemented an AI model trained to detect STEMI and STEMI equivalents, PMcardio Queen of Hearts (eOMI v1), via smartphones in a STEMI network and compared its readings with outcomes in 731 consecutive patients presenting with cardiac chest pain over 10 weeks in 2024. Outcomes were adjudicated by chart review, and 23 patients (3%) had angiographic STEMI. The AI model detected 95% of STEMIs versus 48% for the ECG machine, at comparable specificity (95% vs 96%). It correctly identified 15 cases the ECG machine missed, 80% of which were STEMI equivalents, while AI-assisted emergency physicians reached 78% sensitivity.
Key findings
- Among 731 consecutive chest pain patients, the AI model had significantly higher sensitivity for STEMI than the ECG machine (95% vs 48%, p<0.001).
- Specificity was comparable (95% for the AI model vs 96% for the ECG machine), with overall superior predictive accuracy for the AI model (χ²=8.1, p=0.004).
- The AI model correctly identified 15 cases that the ECG machine missed; 80% of these were STEMI equivalents.
- AI-assisted emergency physicians had a sensitivity of 78%, indicating potential instances of AI underutilization.
Published in: ACC.25 – presented as a moderated poster (Journal of the American College of Cardiology, Volume 85, Issue 12, Supplement A)
Published on: 30 March 2025
Background
Detection of ST-segment elevation myocardial infarction (STEMI) at the first point of patient contact is poor, with frequent misidentification and false positives. An artificial intelligence (AI) electrocardiogram (ECG) model had outperformed standard-of-care STEMI detection in international retrospective cohorts, and this study assessed it prospectively in a real-world STEMI network.
Methods
An AI model trained to detect STEMI and STEMI equivalents (PMcardio Queen of Hearts, eOMI v1) was implemented using smartphones in a STEMI network linking emergency medical services, spoke hospital emergency departments and a PCI hub. Outcomes of consecutive patients presenting with cardiac chest pain during a 10-week period in 2024 were adjudicated using chart review and classified based on the presence of angiographic STEMI. The sensitivity and specificity of the AI model were compared with those of the ECG machine interpretation, and the sensitivity of AI-assisted emergency physicians was also assessed.
Results
A total of 731 consecutive patients (68% male) were included, of whom 23 (3%) met the primary outcome of STEMI. The AI model recorded a significantly higher sensitivity than the ECG machine (95% vs 48%, p<0.001) at comparable specificity (95% vs 96%, respectively), with overall superior predictive accuracy (χ²=8.1; p=0.004). The AI model correctly identified 15 cases that the ECG machine missed, 80% of which were STEMI equivalents. The sensitivity of AI-assisted emergency physicians interpreting STEMI was 78%, indicating potential instances of AI underutilization.
Conclusion
This first prospective validation in a large all-comer chest pain cohort indicates high accuracy of unbiased, AI-powered ECG interpretation. These real-world findings suggest its potential to improve STEMI patient detection and outcomes through timely referral for invasive management.
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About PMcardio
PMcardio is the market leader in AI-powered diagnostics, addressing the world’s leading cause of death – cardiovascular diseases. The innovative clinical assistant empowers healthcare professionals to detect up to 40 cardiovascular diseases. In the form of a smartphone application, the certified Class IIb medical device interprets any 12-lead ECG image in under 5 seconds to provide accurate diagnoses and individualized treatment recommendations tailored to each patient.
About Powerful Medical
Powerful Medical leads one of the most important shifts in modern medicine by augmenting human-made clinical decisions with artificial intelligence. Our primary focus is on cardiovascular diseases, the world’s leading cause of death.
Established in 2017, Powerful Medical has embarked on a mission to revolutionize the diagnosis and treatment of cardiovascular diseases. We are a medical company backed by 28 world-class cardiologists and led by our expert Scientific Board with decades of experience in daily patient care, clinical research, and medical devices. The results of our research are implemented, developed, certified, and brought to market by our 50+ strong interdisciplinary team of physicians, data scientists, AI experts, software engineers, regulatory specialists, and commercial teams.
