Key result
Initial 80-lead body surface potential mapping identified acute myocardial infarction with 91% sensitivity and a c-statistic of 0.803 in patients with a nondiagnostic 12-lead ECG and culprit left circumflex occlusion.
Why the study?
Left circumflex culprit lesions are often missed by standard 12-lead ECG, and extended lead systems such as body surface potential mapping should improve diagnosis.
Does an 80-lead body surface potential map improve the diagnosis of acute myocardial infarction in patients with a nondiagnostic 12-lead ECG and culprit left circumflex occlusion?
Cohort (n=314)
Blinded interpretation of ECG and BSPM
No
Does an 80-lead body surface potential map improve the diagnosis of acute myocardial infarction in patients with a nondiagnostic 12-lead ECG and culprit left circumflex occlusion?
In patients with a nondiagnostic 12-lead ECG and culprit left circumflex occlusion, an 80-lead body surface potential map identifies ST-segment elevation in extended territories, improving the diagnosis of acute myocardial infarction.
May aid detection of circumflex occlusion missed by standard ECG; hypothesis-generating and requires prospective validation.
Background Left circumflex culprit is often missed by the standard 12-lead ECG . Extended lead systems (body surface potential map [ BSPM ]) should improve the diagnosis of culprit left circumflex stenosis with myocardial infarction. Methods and Results Retrospective analysis of a hospital research registry (August 2000-August 2010) comprising consecutive patients with (1) ischemic-type chest pain at rest; (2) 12-lead ECG and 80-lead BSPM at first medical contact; and (3) cardiac troponin-T 12 hours after symptom onset and/or creatine kinase MB fraction, were undertaken. Enrolled in the cohort were patients with culprit left circumflex stenosis (thrombolysis in myocardial infarction flow grade 0/1) at angiography. Acute myocardial infarction AMI was defined as cardiac troponin-T ≥0.1 μg/L and/or creatine kinase MB fraction >2 upper limits of normal. Enrolled were 482 patients: 168 had exclusion criteria. Of the remaining 314 (age 64±11 years; 62% male), 254 (81%) had AMI : of these, 231 had BSPM STE -sensitivity 0.91, specificity 0.72, positive predictive value 0.93, negative predictive value 0.65, and c-statistic 0.803 for AMI ( P<0.001). Of those with BSPM STE and AMI (n=231), STE was most frequently detected in the posterior (n=111, 48%), lateral (n=53, 23%), inferior (n=39, 17%), and right ventricular (n=21, 9%) territories. Conclusions Among patients with 12-lead ECG non-ST-segment-elevation myocardial infarction and culprit left circumflex stenosis, initial BSPM identifies ST-segment elevation beyond the territory of the 12-lead ECG . Greater use of the BSPM may result in earlier identification of AMI , which may lead to more rapid reperfusion.
No takes yet. Share an insight, caveat, or question.
Daly et al. (2019) conducted a cohort in Nondiagnostic 12-lead ECG with culprit left circumflex occlusion (n=314). 80-lead body surface potential mapping (BSPM) vs. Standard 12-lead ECG was evaluated on Diagnosis of acute myocardial infarction (AMI) (c-statistic 0.803, 95% CI 0.700-0.907, p=<0.001). Initial 80-lead body surface potential mapping identified acute myocardial infarction with 91% sensitivity and a c-statistic of 0.803 in patients with a nondiagnostic 12-lead ECG and culprit left circumflex occlusion.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: