Comparative Study of the Effectiveness of Screening Guidelines for Patients with Ischemic Heart Disease in Screening for ST Elevation Myocardial Infarction at Samut Prakan Hospital

Abstract

BACKGROUND: ST elevation myocardial infarction (STEMI) is a life-threatening emergency that requires timely diagnosis and treatment. Samut Prakan Hospital revised its screening protocol to enhance diagnostic accuracy and reduce time to care.

OBJECTIVES: To compare the effectiveness of the previous and updated screening protocols for patients suspected of ischemic heart disease in identifying STEMI.

METHODS: This retrospective cross-sectional study analyzed 503 patient records divided into two groups, comprising one group of 252 screened using the previous protocol and another group of 251 using the updated protocol. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and time to EKG were analyzed.

RESULTS: The updated protocol yielded a sensitivity of 90%, specificity of 50%, PPV of 26%, and NPV of 96%, with no statistically significant differences compared to the previous protocol. However, patients under the new protocol had a higher proportion of EKG performed within 10 minutes (49% vs. 46%), and the median time to EKG was reduced significantly from 5 to 4 minutes (p=0.031).

CONCLUSIONS: The updated protocol maintained high sensitivity but demonstrated only modest improvements in specificity and predictive accuracy. Further refinement is necessary to improve the screening process, especially in terms of reducing false positives while maintaining prompt care.

Thaiclinicaltrials.org number, TCTR20250803005