ACI-TIPI Java Users Guide

Introduction

The ACI-TIPI Java applet was created for a number of reasons:

Gave me the motivation to learn how to program in JAVA. Provide a readily accessible example such that clinicians interested in predictive instruments can experiment with its utility and applicability in their hospital or clinical setting.

The applet is based on work published by: Harry P. Selker, MD, MSPH, John L. Griffith, MS, Ralph B. D'Agostino, PhD "A Tool for Judging Coronary Care Unit Admission Appropriateness, Valid for Both Real-Time and Retrospective Use: A Time-Insensitive Predictive Instrument (TIPI) for Acute Cardiac Ischemia: A Multicenter Study" Medical Care, Jul 1991, Vol 29, No 7.

Experimenting with the ACI-TIPI Java

The applet is laid out in three areas:

ECG Measurements
Patient Demographics
ACI-TIPI Report

ECG Measurements:

The ECG Measurements is a map of standard "12-lead" ECG leads and associated lead groups:

Anterior lead group - V1, V2, V3, and V4 Lateral lead group - V5, V6, aVL, and I Inferior lead group - II, III, and aVF

The red lines shows physical and anatomic relationship between each of the leads. For example, in the Anterior lead group, V1 and V2 are considered "contiguous" leads. This allows us to develop robust criteria utilizing both the absolute QRS measurements (ST elevation for example) and measurements in the neighboring leads. If we have ST-segment elevation of 0.5 mV in V2, we would expect some ST-segment elevation also in leads V1 and V3 (neighboring or contiguous leads). If only V2 have ST-segment elevation while both V1 and V3 have zero or negative ST-segment change, we may conclude noise or other artifact corrupted the ST-segment measurement in lead V2.

To enter Q-wave duration, ST amplitude (assuming at J+60ms), and T-wave amplitude measurements click on any of the lead buttons. A dialog box will appear for you to enter these measurements.

Patient Demographics:

The ACI-TIPI Java uses three patient demographics to calculate the predicted probability of Acute-Cardiac Ischemia:

Patient Chest or Left Arm equivalent Pain (suggestive of ischemia) Patient Age in years Patient Gender

ACI-TIPI Report:

After you have entered all the data, click on the button marked "Report". This will calculate the ACI-TIPI score and print its findings in the report text box. You can change various aspects of the patient data to see how it decreases or increases the predicted probability.