Key result
Novel ECG T-wave criteria differentiate acute PE from LAD-related ACS with ~94% accuracy.
Why the study?
Patients with acute pulmonary embolism often present with negative T waves in precordial leads, a finding that also occurs in ACS caused by LAD disease.
Observational (n=355)
Single-blind (ECG reader blinded to clinical data)
No
Absolute Event Rate: 98.1% vs 8.1%
p-value: p=<0.01
May support ECG differentiation of acute PE from LAD-ACS; leaves open prospective validation before clinical adoption.
BACKGROUND: Patients with acute pulmonary embolism (APE) often have negative T waves (Neg T) in precordial leads at presentation, but this is also found in acute coronary syndrome (ACS) caused by left anterior descending coronary artery (LAD) disease. METHODS AND RESULTS: Differences in Neg T on admission electrocardiograms were studied between 107 patients with APE and 248 patients with ACS caused by LAD disease. All patients had Neg T in leads V1-4 and were admitted within 7 days from symptom onset. The number of leads with Neg T (4.8±1.8 vs. 5.5±1.7, P<0.001) and maximum magnitude of Neg T (3.4±2.0 vs. 4.7±3.3mm, P<0.001) were lower in APE. The frequency of occurrence of Neg T in each of the 12 leads, and the precordial lead with the greatest Neg T (peak Neg T) differed between APE and ACS (all P<0.05, respectively). APE was strongly associated with the presence of Neg T in both leads III and V1 and peak Neg T in leads V1-2. The combination of these 2 findings identified APE with 98% sensitivity, 92% specificity, and 94% predictive accuracy, which represented the highest diagnostic accuracy. CONCLUSIONS: Among patients with APE and ACS who have precordial Neg T, the presence of Neg T in leads III and V1 and/or peak Neg T in leads V1-2 simply but accurately differentiates APE from ACS.
No takes yet. Share an insight, caveat, or question.
Kosuge et al. (2013) conducted an observational in Acute pulmonary embolism (APE) vs. Acute coronary syndrome (ACS) caused by left anterior descending coronary artery (LAD) disease (n=355). Acute pulmonary embolism (evaluated via ECG criteria: Neg T in leads III and V1 and/or peak Neg T in leads V1-2) vs. Acute coronary syndrome caused by LAD disease was evaluated on Presence of negative T waves in both leads III and V1 and/or peak negative T waves in leads V1-2 (diagnostic sensitivity/rate for identifying APE vs ACS) (p=<0.01). Combining negative T waves in leads III and V1 with/or peak negative T waves in leads V1-2 differentiated acute pulmonary embolism from LAD-related ACS with 98% sensitivity, 92% specificity, and 94% accuracy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: