TY - GEN
T1 - Validation of new enhanced ACC/ESC STEMI criteria on the population of patients with suspected myocardial infarction
AU - Wang, John Y.
AU - Wagner, G. S.
AU - Martin, T. N.
AU - Warren, J. W.
AU - Mirmoghisi, M.
AU - Horáček, B. M.
PY - 2009
Y1 - 2009
N2 - Current electrocardiographic criteria for identifying patients with ST-segment elevation myocardial infarction (STEMI) perform with high specificity (SP), but low sensitivity (SE). Based on data acquired during balloon-inflation angioplasty, we found that the SE of ACC/ESC STEMI criteria can be improved without any loss of SP by considering ST elevation in 3 added pairs of contiguous leads (aVL, -III; III, -aVL; and -V2, -V3). The aim of the present study was to validate these findings on an independent dataset consisting of 12-lead ECGs of patients with (n = 58) and without (n = 58) acute myocardial infarction. ST deviation was measured at J point in 12 standard leads by a cardiologist from paper tracings, with resolution of 50μV; these tracings were then scanned and high-resolution ST measurements were made from computer monitor. By using manual measurements from paper, the detection of ischemic state using the existing STEMI criteria achieved SE/SP of 50/97%, whereas with enhanced STEMI criteria SE/SP were 66/97%. Computer-assisted measurements yielded SE/SP of 43/98% for the existing and 55/98% for enhanced STEMI criteria; however, at thresholds for ST elevation lowered by 30 μV (i.e., by emulating "rounding" in readings from paper) SE/SP values for computer-assisted measurements equaled those for manual ones. Thus this study confirmed that existing ACC/ESC STEMI criteria enhanced by 3 additional features yield improved SE of ischemia detection without lowering SP.
AB - Current electrocardiographic criteria for identifying patients with ST-segment elevation myocardial infarction (STEMI) perform with high specificity (SP), but low sensitivity (SE). Based on data acquired during balloon-inflation angioplasty, we found that the SE of ACC/ESC STEMI criteria can be improved without any loss of SP by considering ST elevation in 3 added pairs of contiguous leads (aVL, -III; III, -aVL; and -V2, -V3). The aim of the present study was to validate these findings on an independent dataset consisting of 12-lead ECGs of patients with (n = 58) and without (n = 58) acute myocardial infarction. ST deviation was measured at J point in 12 standard leads by a cardiologist from paper tracings, with resolution of 50μV; these tracings were then scanned and high-resolution ST measurements were made from computer monitor. By using manual measurements from paper, the detection of ischemic state using the existing STEMI criteria achieved SE/SP of 50/97%, whereas with enhanced STEMI criteria SE/SP were 66/97%. Computer-assisted measurements yielded SE/SP of 43/98% for the existing and 55/98% for enhanced STEMI criteria; however, at thresholds for ST elevation lowered by 30 μV (i.e., by emulating "rounding" in readings from paper) SE/SP values for computer-assisted measurements equaled those for manual ones. Thus this study confirmed that existing ACC/ESC STEMI criteria enhanced by 3 additional features yield improved SE of ischemia detection without lowering SP.
UR - http://www.scopus.com/inward/record.url?scp=77952735250&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77952735250&partnerID=8YFLogxK
M3 - Conference contribution
AN - SCOPUS:77952735250
SN - 9781424472819
T3 - Computers in Cardiology
SP - 109
EP - 112
BT - Computers in Cardiology 2009, CinC 2009
T2 - 36th Annual Conference of Computers in Cardiology, CinC 2009
Y2 - 13 September 2009 through 16 September 2009
ER -