Maximal increase in sensitivity with minimal loss of specificity for diagnosis of acute coronary occlusion achieved by sequentially adding leads from the 24-lead electrocardiogram to the orderly sequenced 12-lead electrocardiogram

• Objectives: This study investigates whether sequential addition of inverted, (negative) leads from the 24-lead electrocardiogram (ECG) to the orderly sequenced 12-lead ECG would identify a number of leads with which the sensitivity for diagnosis of acute transmural ischemia is significantly increased with minimal loss of specificity. Background: Acute transmural ischemia due to thrombotic coronary occlusion typically progresses to infarction. Its recognition is based on currently accepted ST-elevation myocardial infarction (STEMI) criteria with suboptimal sensitivity, which could be potentially increased by consideration of the principle that each of the 12 ECG leads can be inverted to provide an additional lead with the opposite (180 degrees) orientation, generating a 24-lead ECG. Methods: The study population included 162 patients who underwent prolonged coronary occlusion during elective percutaneoas transluminal coronary angioplasty. Balloon occlusion was performed in the left anterior descending coronary artery (51 patients), in the right coronary artery (67 patients), or in the left circumflex coronary artery (44 patients). To be classified as indicative of the epicardial injury current of acute ischemia, the ECGs had to fulfill either the criteria of a consensus document from the American College of Cardiology or the European Society of Cardiology or thresholds for the inverted leads based on a population study from Scotland. Results: The addition of -V1, -V2, -V3, -aVL, -I, aVR, and -III increased sensitivity from 61% to 78% (P <= .01) and decreased specificity from 96% to 93% (P = .06). Conclusions: Addition of 7 leads from the 24-lead ECG, thus creating a 19-lead ECG, was found optimal for attaining high sensitivity while retaining high specificity when compared with the performance of the standard 12-lead ECG. (C) 2007 Elsevier Inc. All rights reserved.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Keyword

PTCA

sensitivity

specificity

acute myocardial infarction

12-lead ECG

acute coronary syndromes

Publication and Content Type

art (subject category)

ref (subject category)