Systematic review and meta-analysis of diagnostic test accuracy of ST-segment elevation for acute coronary occlusion

Objective: To evaluate the diagnostic sensitivity and specificity of STsegment elevation on a 12lead ECG in detecting ACO across any coronary artery, challenging the current STEMI-NSTEMI paradigm.Methods: Studies from MEDLINE and Scopus (2012-2023) comparing ECG findings with coronary angiograms were systematically reviewed and analyzed following PRISMA-DTA guidelines.QUADAS-2 assessed the risk of bias.Study selection: Studies included focused on AMI patients and provided data enabling the construction of con-tingency tables for sensitivity and specificity calculation, excluding those with non-ACS conditions, outdated STEMI criteria, or a specific focus on bundle branch blocks or other complex diagnoses.Data were extracted systematically and pooled test accuracy estimates were computed using MetaDTA software, employing bivariate analyses for within-and between-study variation.The primary outcomes measured were the sensitivity and specificity of STsegment elevation in detecting ACO.Results: Three studies with 23,704 participants were included.The pooled sensitivity of ST-segment elevation for detecting ACO CAPÍTULO 3 Systematic review and meta-analysis of diagnostic test accuracy of ST-segment elevation for acute coronary occlusion was 43.6% (95% CI: 34.7%-52.9%),indicating that over half of ACO cases may not exhibit ST-segment elevation.The specificity was 96.5% (95% CI: 91.2%-98.7%).Additional analysis using the OMI-NOMI strategy showed improved sensitivity (78.1%, 95% CI: 62.7%-88.3%)while maintaining similar specificity (94.4%, 95% CI: 88.6%-97.3%).Conclusion: The findings reveal a significant diagnostic gap in the current STEMI-NSTEMI paradigm, with over half of ACO cases potentially lacking ST-segment elevation.The OMI-NOMI strategy could offer an improved diagnostic approach.The high heterogeneity and limited number of studies necessitate cautious interpretation and further research in diverse settings.