Acute Detection of ST-Elevation Myocardial Infarction Missed on Standard 12-Lead ECG With a Novel 80-Lead Real-Time Digital Body Surface Map: Primary Results From the Multicenter OCCULT MI Trial

Incremental Benefit of 80‐Lead Electrocardiogram Body Surface Mapping Over the 12‐Lead Electrocardiogram in the Detection of Acute Coronary Syndromes in Patients Without ST‐elevation Myocardial Infarction: Results from the Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction (OCCULT MI) Trial

“…16,17 In the OCCULT MI trial primary analysis, the 80L was able to identify an additional 25 patients (or a 27.5% increase in sensitivity) with missed STEMI compared to the 12L. 13 As a practical matter, when door-to-balloon times of less than 60 minutes are advocated, every ED is finding ways to shave minutes off their STEMI process times. Therefore, adding 3-4 minutes to the STEMI process to obtain an 80L with little potential benefit is not clinically efficacious or practical.…”

“…13 A sample size of 1,400 patients or 280 MIs was chosen to provide at least 80% power to detect a significant difference in the door-to-sheath time distribution between 80L only STEMI and 12L STEMI at a two-sided alpha of 0.05, under these assumptions. The final sample size was increased to 1,800 patients based on a blinded interim analysis by the study data safety and monitoring board.…”

“…13 This study was approved by the institutional review boards of each site. All patients gave written, informed consent.…”

“…4,[8][9][10][11] The use of the 80L in a more representative, moderate-to high-risk ED population has, to the best of our knowledge, never been reported prior to the Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction (OCCULT MI) study. 13 In addition, the analysis of ST depression as a high-risk ECG finding and the sensitivity of the 80L ECG for detection of ST depression or ST elevation in patients with MI and ACS have never been studied. Yet, prediction of MI and ACS and early risk stratification of these patients into invasive or aggressive care pathways have been linked to improved outcomes.…”

Ischemic heart disease in the emergency room: state of the art, innovation and research

“…When body surface mapping information is presented in this latter fashion, the use of 80-lead ECG provides a remarkable 81% increase in sensitivity for detecting AMI compared to a standard 12-lead ECG. 27 Most improvements in sensitivity with the 80-lead ECG occur as a result of superior detection of AMI in those anatomic regions known to be challenging for the 12-lead ECG. For example, this includes a 13.5 fold improvement in the rate of a correct diagnosis of posterior AMI, and a 1.4 times improvement in detecting right ventricular (RV) infarcts, even when a V4R lead is added to the routine 12-lead ECG.…”