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European Heart Journal 2001 22(3):218-227; doi:10.1053/euhj.2000.2146
Copyright © 2001 by the European Society of Cardiology.
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ST depression only on the initial 12-lead ECG: early diagnosis of acute myocardial infarction

I.B.A Menowna, J Allenb, J.McC Andersonb and A.A.J Adgeya,f1

a Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast
b University of Ulster, Jordanstown, Northern Ireland, U.K.

revised February 15, 2000; accepted February 17, 2000

Abstract

Aims To compare the diagnostic ability of the 12-lead ECG with body surface mapping for early detection of acute myocardial infarction in patients presenting with ST depression only on the 12-lead ECG.

Methods and Results Fifty-four consecutive patients with chest pain <24h and ST depression were recruited. A 12-lead ECG and 80-lead body surface map were recorded at presentation from which univariate and multivariate prediction models of acute myocardial infarction were developed. Patients were randomly divided into a training-set and a validation-set. Acute myocardial infarction occurred in 16/30 training-set and 8/24 validation-set patients. Univariate prediction of acute myocardial infarction by the 12-lead ECG, based on the depth or numbers of leads with ST depression, was not improved by assessment of ST elevation outside the conventional 12 leads using body surface mapping. The optimum multivariate 12-lead ECG model developed in training-set patients (six ST depression variables) had poor sensitivity (38%) although good specificity (81%) for acute myocardial infarction when tested prospectively in validation-set patients. In contrast, the optimum body surface mapping model developed in training-set patients (three isointegral or isopotential variables) achieved high sensitivity (88%) whilst maintaining good specificity (75%) for acute myocardial infarction when tested prospectively in validation-set patients.

Conclusion Body surface mapping, when compared with the 12-lead ECG, may improve the early diagnosis of acute myocardial infarction in patients presenting with chest pain and ST depression only on the 12-lead ECG.

Key Words: Body surface mapping, electrocardiography, myocardial infarction, diagnosis

f1 Correspondence: Professor A. A. J. Adgey, Regional Medical Cardiology Centre, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, U.K.

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