Comparison of model-based and expert-rule based electrocardiographic identification of the culprit artery in patients with acute coronary syndrome

Kamphuis, Vivian P.; Wagner, Galen S.; Pahlm, Olle; Man, Sumche; Olson, Charles W.; Bachárová, Ljuba; Swenne, Cees A.

doi:10.1016/j.jelectrocard.2015.05.003

Cited by 8 publications

(4 citation statements)

References 35 publications

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“…31 Culprit artery identification can be performed with high accuracy using EDS-MI. 7 However, the ECG reflects only the ischaemic area and not the perfusing artery, and coronary anatomy varies between individuals. Given that the applied techniques are validated for the scanners used, T2-weighted imaging 22,32 or contrast-enhanced steady state free precession 33,34 CMR provides accurate information on the location of the ischaemic myocardium and can serve as reference standard in this context.…”

Section: Discussionmentioning

confidence: 99%

“…The Regional Ethical Review Board in Lund approved the study. Anonymized data from previous studies 7,13,14 were included in this study. Necessary ethical approval for these studies was obtained by the regional ethical boards.…”

Section: Ethical Considerationsmentioning

confidence: 99%

“…From two previous studies, 7,14 117 patients referred to acute primary PCI and with verified acute coronary occlusion were included in this study ( Table 2). ECGs were recorded within 3 h from PCI (98% within 2 h).…”

Section: Patients With Acute Coronary Occlusionmentioning

confidence: 99%

“…6 EDS-MI has previously proved to accurately identify the culprit artery in patients with acute coronary occlusion. 7 A recent study indicated that EDS-MI has higher sensitivity than STEMI criteria. 8 There are several non-ischaemic conditions that can mimic STEMI, such as acute perimyocarditis, early repolarization syndrome (ERS) and takotsubo cardiomyopathy.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Accuracy Of The Electrocardiographic Decision Support – Myocardial Ischaemia (EDS-MI) Algorithm In Detection Of Acute Coronary Occlusion

Lindow

Pahlm

Olson³

et al. 2018

European Heart Journal: Acute Cardiovascular Care

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Electrocardiographic Decision Support - Myocardial Ischaemia (EDS-MI) is a graphical decision support for detection and localization of acute transmural ischaemia. A recent study indicated that EDS-MI performs well for detection of acute transmural ischaemia. However, its performance has not been tested in patients with non-ischaemic ST-deviation. We aimed to optimize the diagnostic accuracy of EDS-MI in patients with verified acute coronary occlusion as well as patients with non-ischaemic ST deviation and compare its performance with STEMI criteria. We studied 135 patients with non-ischaemic ST deviation (perimyocarditis, left ventricular hypertrophy, takotsubo cardiomyopathy and early repolarization) and 117 patients with acute coronary occlusion. In 63 ischaemic patients, the extent and location of the ischaemic area (myocardium at risk) was assessed by both cardiovascular magnetic resonance imaging and EDS-MI. Sensitivity and specificity of ST elevation myocardial infarction criteria were 85% (95% confidence interval (CI) 77, 90) and 44% (95% CI 36, 53) respectively. Using EDS-MI, sensitivity and specificity increased to 92% (95% CI 85, 95) and 81% (95% CI 74, 87) respectively (p=0.035 and p<0.001). Agreement was strong (83%) between cardiovascular magnetic resonance imaging and EDS-MI in localization of ischaemia. Mean myocardium at risk was 32% (± 10) by cardiovascular magnetic resonance imaging and 33% (± 11) by EDS-MI when the estimated infarcted area according to Selvester QRS scoring was included in myocardium at risk estimation. In conclusion, EDS-MI increases diagnostic accuracy and may serve as an automatic decision support in the early management of patients with suspected acute coronary syndrome. The added clinical benefit in a non-selected clinical chest pain population needs to be assessed.

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