Key result
Consideration of both ST-segment elevation and depression on admission ECG increased sensitivity for AMI detection from 50% to 84% (p<0.0001) with a slight decrease in specificity from 97% to 93%.
Why the study?
Existing 12-lead ECG STEMI criteria and similar ST-segment depression criteria needed validation against ceMRI as the diagnostic gold standard for acute myocardial infarction.
Does considering ST-segment depression in addition to ST-segment elevation on admission ECG improve the diagnosis of acute myocardial infarction compared to ST-segment elevation alone in patients with chest pain?
Observational (n=116)
Does considering ST-segment depression in addition to ST-segment elevation on admission ECG improve the diagnosis of acute myocardial infarction compared to ST-segment elevation alone in patients with chest pain?
Incorporating ST-segment depression alongside ST-segment elevation criteria on admission ECG significantly improves sensitivity for detecting acute myocardial infarction with minimal loss of specificity.
Adding ST depression to STEMI criteria raises AMI sensitivity from 50% to 84%; extends ECG validation against ceMRI gold standard.
OBJECTIVES: The purpose of this study was to validate existing 12-lead electrocardiographic (ECG) ST-segment elevation myocardial infarction (STEMI) criteria in the diagnosis of acute myocardial infarction (AMI) and the application of similar ST-segment depression (STEMI-equivalent) criteria with contrast-enhanced cardiac magnetic resonance imaging (ceMRI) as the diagnostic gold standard. BACKGROUND: The admission ECG is the cornerstone in the diagnosis of AMI, and ceMRI is a new diagnostic gold standard that can be used to validate existing and novel 12-lead ECG criteria. METHODS: One hundred fifty-one consecutive patients with their first hospital admission for chest pain underwent ceMRI. The 116 patients without ECG confounding factors were included in this study, and AMI was confirmed in 58 (50%). The admission ECG was evaluated on the basis of the lead distribution of ST-segment deviation according to current American College of Cardiology/European Society of Cardiology (ACC/ESC) guidelines. RESULTS: A sensitivity of 50% and specificity of 97% for AMI were achieved with the currently applied ST-segment elevation criteria. Consideration of ST-segment depression in addition to elevation increased sensitivity for detection of AMI from 50% to 84% (p < 0.0001) but only decreased specificity from 97% to 93% (p = 0.50). There were no significant differences in AMI location or size between patients meeting the 12-lead ACC/ESC ST-segment elevation criteria and those only meeting the ST-segment depression criteria. CONCLUSIONS: In patients admitted to hospital with possible AMI, the consideration of both ST-segment elevation and depression in the standard 12 lead-ECG recording significantly increases the sensitivity for the detection of AMI with only a slight decrease in the specificity.
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Martin et al. (2007) conducted an observational in Acute myocardial infarction (n=116). Consideration of both ST-segment elevation and depression vs. ST-segment elevation criteria alone was evaluated on Sensitivity for detection of AMI (p=< 0.0001). Consideration of both ST-segment elevation and depression on admission ECG increased sensitivity for AMI detection from 50% to 84% (p<0.0001) with a slight decrease in specificity from 97% to 93%.
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