Copyright © 1997 by the European Society of Cardiology.
© 1997 The European society of Cardiology
Comparison of usefulness of computer assisted continuous 48-h 3-lead with 12-lead ECG ischaemia monitoring for detection and quantitation of ischaemia in patients with unstable angina
*Division of Cardiology, Thoraxcenter, University Hospital Dijkzigt, Erasmus University Rotterdam The Netherlands
Data processing center Cardialysis B. V. Rotterdam, The Netherlands
Division of Cardiology, Spaarne Ziekenhuis Heemstede, The Netherlands
Division of Cardiology, Medisch Centrum Alkmaar Alkmaar, The Netherlands
Received 2 August 1996; accepted 9 August 1996.
Correspondence: A. P. J. Klootwijk MD, Thoraxcenter Ba 316, Erasmus University Rotterdam, University Hospital Dijkzigt, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
Abstract
AIMS: The selection of ECG leads used for ST monitoring may influence detection and quantitation of ischaemia.
METHODS: We compared on-line continuous 48-h 12-lead against 3-lead ST monitoring in 130 unstable angina patients (Mortara, ELI-100). Onset and offset of ST episodes were defined by the lead with the first 
100 µV ST change relative to baseline and the lead with the latest return to baseline ST level, respectively. ST episodes were calculated for 12 leads and 3 leads (V2, V5, III) separately.
RESULTS: ST episodes were detected in 88 patients (77%) by 12-lead and in 71 patients (62%) by 3-lead ST monitoring (P<0·02). The median number (25, 75%) of episodes/patient was 1 (0, 3) for 3-lead and 2 (1, 6) for 12-lead (p<0·0001). The total duration of ischaemia detected during 12-lead far exceeded 3-lead monitoring: 12·3 (1, 58·2) and 1·7 (0, 23·3) min respectively (p<0·0001). The probability of recurrent ischaemia declined most during the first 24 h of monitoring. After a period without ST changes of 1, 12, 24 and 36 h, the probabilities of recurrent ischaemia were 63, 31, 14 and 9%, respectively.
CONCLUSIONS: Continuous 12-lead ST monitoring increases detection rate and duration of ST episodes compared to 3-lead ST monitoring. The use of continuous 12-lead ECG monitoring devices on emergency wards and coronary care units is recommended.
Key Words: ST monitoring • unstable angina • ECG leads
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