Real-Time Integration of an AI-Based ECG Interpretation System in the Emergency Department: A Pragmatic Alternating-Day Study of Diagnostic Performance and Clinical Process Metrics

Real-time AI-ECG integration in the ED was associated with improved STEMI detection sensitivity and shorter reperfusion-related time metrics, particularly in atypical presentations, and with reduced hospital LOS among admitted patients. Short-term mortality was comparable between groups. Further multicenter studies are warranted to confirm generalizability and to balance benefits against potential false-positive-related operational impacts.