Sex-Consistent Performance of an AI-Enabled ECG for Acute Myocardial Infarction: The ROMIAE Study
Authors' conclusion
In a prospective, multicenter emergency department cohort, AI-ECG demonstrated sex-consistent diagnostic performance and preserved rule-out safety for AMI. Further validation and implementation studies are warranted. (ROMIAE [Rule-Out Acute Myocardial Infarction Using Artificial Intelligence Electrocardiogram Analysis] Trial; NCT05435391).
Study context
- Population
- Adults with suspected acute myocardial infarction (AMI) in the emergency departmentwomen 3,186
- Participants
- 8,493 patients
- Index test or model
- AI-ECG analysis of initial ECGs for AMI, using prespecified risk thresholds
- Target condition
- acute myocardial infarction (AMI)
Methodological details18 centers in South Korea, multicenter emergency department cohort, sex-stratified analyses, prespecified subgroup analyses
- 18 centers in South Korea
- Multicenter emergency department cohort
- Sex-stratified analyses
- Prespecified subgroup analyses
Performance
As reported in the abstract
| Test or model | Area under the receiver-operating characteristic curve | Rule-out sensitivity at the prespecified low-risk cutoff | Negative predictive value |
|---|---|---|---|
| Women | 0.875 [95% CI: 0.853-0.896] | 98.8% (95% CI: 97.0-99.5) | 99.2% [95% CI: 97.9-99.7] |
| Men | 0.871 [95% CI: 0.858-0.883] | 99.8% (95% CI: 99.4-100.0) | 99.1% [95% CI: 96.7-99.7] |
Area under the receiver-operating characteristic curve
Women0.875 [95% CI: 0.853-0.896]
Men0.871 [95% CI: 0.858-0.883]
Rule-out sensitivity at the prespecified low-risk cutoff
Women98.8% (95% CI: 97.0-99.5)
Men99.8% (95% CI: 99.4-100.0)
Negative predictive value
Women99.2% [95% CI: 97.9-99.7]
Men99.1% [95% CI: 96.7-99.7]
- Missed AMI rates in both sexes
- <1%
Further findings
- Performance remained stable across ST-segment elevation and non-ST-segment elevation myocardial infarction, without degradation in women
Original publication
Sex-Consistent Performance of an AI-Enabled ECG for Acute Myocardial Infarction: The ROMIAE Study. JACC Adv. Published June 2026. doi:10.
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