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Improved detection of acute myocardial infarction using a diagnostic algorithm based on calculated epicardial potentials.

Colum Owens·César Navarro·Anthony McClelland·John Riddell·Omar Escalona·John McC Anderson·Jennifer Adgey
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Abstract

BACKGROUND: New methods for detecting myocardial infarction in patients with suspected acute coronary syndromes are needed particularly in an era where the majority of patients with myocardial infarction present with non-diagnostic 12-lead electrocardiograms (ECG). We compared a novel epicardial diagnostic algorithm using epicardial potentials from the 80-lead body surface map with other electrocardiographic techniques in detection of myocardial infarction. METHODS: Between February 1999 and February 2001, consecutive patients (n=427) with ischemic type chest pain had an initial 12-lead ECG and body surface map recorded. Detecting myocardial infarction using an epicardial algorithm was first performed in a training set (n=213) and tested in a validation set of patients (n=214). The results from this epicardial algorithm in myocardial infarction detection were compared with the physician's interpretation of the 12-lead ECG, the body surface map algorithm (PRIME) and physician's interpretation of the body surface map. RESULTS: Myocardial infarction occurred in 205 patients (creatine kinase >or=2x upper limit of normal with creatine kinase-MB >or=7% CK). The physician's interpretation of the 12-lead ECG identified 122 with myocardial infarction (sensitivity 60%, specificity 99%), the body surface map algorithm 137 (sensitivity 67%, specificity 89%), the physician's interpretation of the body surface map 153 (sensitivity 75%, specificity 91%) and the epicardial algorithm 158 (sensitivity 77% specificity 99%). Combining the physician's interpretation of the 12-lead ECG with the epicardial algorithm increased significantly the detection of myocardial infarction (sensitivity 85%, specificity 98%, p<0.001) compared with the 12-lead ECG. CONCLUSIONS: An epicardial algorithm based on epicardial potentials increases significantly the detection of myocardial infarction particularly among those with non-diagnostic 12-lead ECG's.

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AgedAlgorithmsElectric ConductivityElectrocardiographyFemaleHumansMaleMiddle AgedMyocardial InfarctionPhantoms, ImagingReproducibility of ResultsJournal ArticleResearch Support, Non-U.S. Gov't

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Colum Owens, César Navarro, Anthony McClelland, John Riddell, Omar Escalona, John McC Anderson, Jennifer Adgey. 2005-12-20. Improved detection of acute myocardial infarction using a diagnostic algorithm based on calculated epicardial potentials.. https://doi.org/10.1016/j.ijcard.2005.09.050

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