{
  "id": "medical/misinterpretation-of-ecg-st-elevation-for-benign-early-repolarization",
  "signature": "AI interprets ST elevation on an ECG as acute myocardial infarction in a young healthy adult, leading to unnecessary emergency catheterization",
  "signature_zh": "AI将年轻健康成人心电图上的ST段抬高解读为急性心肌梗死，导致不必要的紧急导管检查",
  "regex": "(?i)(ST elevation|STEMI).*(young|athlete|benign early repolarization|BER).*(false positive|unnecessary|catheterization)",
  "domain": "medical",
  "category": "data_error",
  "subcategory": null,
  "root_cause": "Benign early repolarization (BER) is a normal variant seen in up to 5% of the population, especially young males, characterized by concave ST elevation in precordial leads; AI models often lack specificity to differentiate it from ST-elevation myocardial infarction (STEMI) patterns.",
  "root_cause_type": "generic",
  "root_cause_zh": "良性早期复极（BER）是一种正常变异，见于高达5%的人群，尤其是年轻男性，特征为心前导联凹面型ST段抬高；AI模型常缺乏区分其与ST段抬高型心肌梗死（STEMI）模式的特异性。",
  "versions": [
    {
      "version": "GE Marquette 12SL v24",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Philips DXL v3.0",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "CardioSoft v6.73",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "BER is a diagnosis of exclusion; without chest pain or troponin elevation, immediate catheterization is not indicated and carries procedural risks.",
      "fail_rate": 0.8,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Automated interpretations have high false-positive rates for STEMI in young populations; physician expertise is needed.",
      "fail_rate": 0.7,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "BER typically shows ST elevation in V2-V4 without reciprocal depression, while STEMI often shows reciprocal changes in inferior leads.",
      "fail_rate": 0.6,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Implement a two-step AI pipeline: first detect ST elevation, then apply a secondary model trained specifically to distinguish BER from STEMI using features like J-point notching, concave ST morphology, and absence of reciprocal changes.",
      "success_rate": 0.9,
      "how": "Implement a two-step AI pipeline: first detect ST elevation, then apply a secondary model trained specifically to distinguish BER from STEMI using features like J-point notching, concave ST morphology, and absence of reciprocal changes.",
      "condition": "",
      "sources": []
    },
    {
      "action": "Require the AI to output a confidence score and flag any ECG with ST elevation in patients under 40 without chest pain for manual physician review before activating cath lab.",
      "success_rate": 0.85,
      "how": "Require the AI to output a confidence score and flag any ECG with ST elevation in patients under 40 without chest pain for manual physician review before activating cath lab.",
      "condition": "",
      "sources": []
    },
    {
      "action": "Integrate a clinical decision rule: if the patient is under 40, has no cardiac risk factors, and has concave ST elevation in V2-V4 without reciprocal changes, recommend serial troponin and repeat ECG in 6 hours rather than immediate catheterization.",
      "success_rate": 0.88,
      "how": "Integrate a clinical decision rule: if the patient is under 40, has no cardiac risk factors, and has concave ST elevation in V2-V4 without reciprocal changes, recommend serial troponin and repeat ECG in 6 hours rather than immediate catheterization.",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Implement a two-step AI pipeline: first detect ST elevation, then apply a secondary model trained specifically to distinguish BER from STEMI using features like J-point notching, concave ST morphology, and absence of reciprocal changes.",
    "Require the AI to output a confidence score and flag any ECG with ST elevation in patients under 40 without chest pain for manual physician review before activating cath lab.",
    "Integrate a clinical decision rule: if the patient is under 40, has no cardiac risk factors, and has concave ST elevation in V2-V4 without reciprocal changes, recommend serial troponin and repeat ECG in 6 hours rather than immediate catheterization."
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.108.189701",
  "official_doc_section": null,
  "error_code": "ECG-STEMI-FALSE-POSITIVE-BER",
  "verification_tier": "ai_generated",
  "confidence": 0.85,
  "fix_success_rate": 0.82,
  "resolvable": "true",
  "first_seen": "2024-03-22",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}