Detection of acute myocardial infarction using the 12‐lead ECG plus inverted leads versus the 16‐lead ECG (with additional posterior and right‐sided chest electrodes)

Abstract

SUMMARYBackground: The electrocardiographic (ECG) diagnosis of acute myocardial infarction (MI) should be improved. This might be done either by regarding all 24 aspects (both positive and negative leads), or a subset hereof (for example 19-lead ECG), of the conventional 12-lead ECG or by using additional electrodes. The purpose of the study was to investigate the accuracy of the different ECG methods in diagnosing acute ST-elevation MI.Methods: The study population consisted of 479 patients admitted to Lund University Hospital with acute chest pain. One conventional ECG plus leads V4R, V5R, V8, and V9 were recorded for each patient within 24 hours of admittance. Biochemical markers were used as the "gold standard" for diagnosis of MI. We measured STsegment elevations in the 12-lead, 16-lead, and 24-lead postadmission ECGs as well as in the 12-lead, 19-lead and 24-lead admission ECGs.Results: The sensitivity for detecting acute MI was 28% for the postadmission 12-lead ECG, 33% for the 16-lead ECG, and 37% for the 24-lead ECG. The specificities were 97%, 93%, and 95%, respectively. For admission ECGs, the sensitivity was 33% for the 12-lead ECG, 45% for the 19-lead ECG and 49% for the 24-lead ECG, with specificities of 97%, 96%, and 94%, respectively.Conclusions: The sensitivity for detecting acute MI was higher for the 16-, 19-and 24-lead ECGs than for the conventional 12-lead ECGs. Their specificity, however, was slightly lower. If increased sensitivity for detecting MI is desired, the 24-lead or 19-lead should be used since no additional electrodes are required.

ECG-Based Detection of Early Myocardial Ischemia in a Computational Model: Impact of Additional Electrodes, Optimal Placement, and a New Feature for ST Deviation

“…The detection of ST deviations in patient electrocardiograms is an essential method for the diagnosis of myocardial ischemia. Both clinical studies [ 1 – 6 ] and simulations [ 7 , 8 ] have shown that some forms of ischemia are visible neither in the standard ECG (see Table 1 ; sensitivity varies between 45% and 73% for detection of ST segment elevation) nor in body surface potential maps (BSPMs) [ 2 , 4 – 6 ]. Such “electrically silent” ischemia results in non-ST elevation myocardial infarction (NSTEMI).…”

Diagnostic Accuracy of a New Cardiac Electrical Biomarker for Detection of Electrocardiogram Changes Suggestive of Acute Myocardial Ischemic Injury

“…The use of cardiac serum markers as a supplement to the ECG has become standard in the assessment and risk stratification of acute myocardial ischemic injury 12–16. In fact, serum troponin evaluation has recently become a gold standard for the diagnosis of myocardial necrosis 17–20.…”

“…[7][8][9][10][11] The use of cardiac serum markers as a supplement to the ECG has become standard in the assessment and risk stratification of acute myocardial ischemic injury. [12][13][14][15][16] In fact, serum troponin evaluation has recently become a gold standard for the diagnosis of myocardial necrosis. [17][18][19][20] However, serum troponin results are generally not immediately available, such that the emergency physician (EP) must implement AMI treatment protocols by relying only on the initial patient evaluation and associated 12-lead ECG interpretation.…”

A Deep-learning Algorithm With the Real World Validation for Detecting Acute Myocardial Infarction

“…The sensitivity of manual interpretation for MI detection using a 12-lead ECG is only from 61 to 74% with the speci city ranging from 72 to 89.0%. [32][33][34][35] In contrast to previously prehospital computer algorithm interpretation for STEMI with the sensitivity of approximately 69%. [36][37][38] Our DLM provides extraordinary performance, which supports decision-making systems in clinical practice.…”