Document Detail

12-lead ST-segment monitoring vs single-lead maximum ST-segment monitoring for detecting ongoing ischemia in patients with unstable coronary syndromes.
MedLine Citation:
PMID:  9740885     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: 12-lead ECG monitoring of the ST segment is more sensitive than patients' symptoms for detecting ischemia after thrombolytic therapy or catheter-based interventions, but it is unclear whether monitoring of the single lead showing maximum ST deviation would be as efficacious. OBJECTIVE: To determine whether monitoring all 12 ECG leads for changes in the ST segment is necessary to detect ongoing ischemia in patients with unstable coronary syndromes. METHODS: Continuous 12-lead ST segment monitoring was performed in 422 patients from the onset of myocardial infarction or during balloon inflation in catheter-based interventions until the patient's discharge from the cardiac care unit. Computer-assisted techniques were used to determine (1) which lead showed the maximum ST deviation at the onset of myocardial infarction or during balloon inflation and (2) what proportion of later ischemic events were associated with ST deviation in this lead. RESULTS: The lead with the maximum ST deviation could be determined in 312 patients (74%). The remaining 110 (26%) had non-Q wave infarction without ST deviation or no ST changes during balloon inflation. During 18,394 hours of 12-lead ST monitoring, 118 (28%) of the 312 patients had a total of 463 ischemic events, 80% of which were silent. Of 377 ischemic events in which a maximum ST lead was detected, 159 (42%) did not show ST deviation in this lead (sensitivity, 58%; 95% CI, 53%-63%). Routine monitoring of leads V1 and II showed ST deviation in only 152 of the 463 events (sensitivity, 33%; 95% CI, 29%-37%). CONCLUSIONS: Monitoring of all 12 ECG leads for changes in the ST segment is necessary to detect ongoing ischemia in patients with unstable coronary syndromes.
B J Drew; M M Pelter; M G Adams; S F Wung; T M Chou; C L Wolfe
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  American journal of critical care : an official publication, American Association of Critical-Care Nurses     Volume:  7     ISSN:  1062-3264     ISO Abbreviation:  Am. J. Crit. Care     Publication Date:  1998 Sep 
Date Detail:
Created Date:  1998-11-12     Completed Date:  1998-11-12     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9211547     Medline TA:  Am J Crit Care     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  355-63     Citation Subset:  IM; N    
Department of Physiological Nursing, University of California, San Francisco, USA.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary
Decision Trees
Electrocardiography / instrumentation*,  methods*
Heart Catheterization / adverse effects
Middle Aged
Monitoring, Physiologic / instrumentation,  methods
Myocardial Ischemia / diagnosis*,  etiology,  therapy
Prospective Studies
Reproducibility of Results
Sensitivity and Specificity
Signal Processing, Computer-Assisted

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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