Wearable 12-lead electrocardiogram for detecting acute myocardial ischemia: a prospective diagnostic accuracy study

Background Timely and accurate identification of myocardial ischemia is critical for improving outcomes in patients with acute chest pain. Although the conventional 12-lead electrocardiogram (ECG) is the standard for detecting ST-segment changes, its dependence on specialized equipment may delay diagnosis. Wearable ECG devices offer a more accessible alternative, but their diagnostic accuracy remains inadequately validated. Purpose To assess the diagnostic accuracy of a wearable 12-lead ECG in detecting ST-segment deviations and occlusive myocardial infarction (OMI) in patients presenting with chest pain. Methods This prospective study enrolled patients presenting with acute chest pain to the emergency department of a tertiary hospital between May 2025 and January 2026. Both conventional and wearable 12-lead ECGs were recorded prior to coronary intervention. Two senior cardiologists, blinded to clinical and angiographic outcomes, independently interpreted all ECGs. OMI was defined as a culprit lesion with Thrombolysis in Myocardial Infarction (TIMI) flow grade 0–2 or TIMI flow grade 3 accompanied by a peak high-sensitivity troponin T level of >1000 ng/L. Results A total of 503 patients were enrolled (mean age 66.4±15.1 years; 66.7% male). Using the conventional 12-lead ECG as the reference standard, the wearable ECG demonstrated high diagnostic accuracy for ST-segment elevation (sensitivity 92.7%, specificity 99.4%) and depression (sensitivity 91.8%, specificity 98.9%). Among 57 patients with confirmed OMI, the wearable ECG showed comparable sensitivity (75.4% vs 78.9%, P=0.48) and specificity (91.2% vs 89.7%, P=0.56) to the conventional 12-lead ECG. The accuracy of culprit vessel identification by ECG was also similar between the two modalities (63.2% vs 66.7%, P=0.52). Conclusions The wearable 12-lead ECG provides high diagnostic accuracy for detecting ST-segment deviations and performs comparably to the standard 12-lead ECG in identifying OMI and localizing the culprit vessel, supporting its potential as a reliable and accessible tool for early triage in acute chest pain.