Document Detail

ST-segment deviation analysis of the admission 12-lead electrocardiogram as an aid to early diagnosis of acute myocardial infarction with a cardiac magnetic resonance imaging gold standard.
MedLine Citation:
PMID:  17825710     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The purpose of this study was to validate existing 12-lead electrocardiographic (ECG) ST-segment elevation myocardial infarction (STEMI) criteria in the diagnosis of acute myocardial infarction (AMI) and the application of similar ST-segment depression (STEMI-equivalent) criteria with contrast-enhanced cardiac magnetic resonance imaging (ceMRI) as the diagnostic gold standard. BACKGROUND: The admission ECG is the cornerstone in the diagnosis of AMI, and ceMRI is a new diagnostic gold standard that can be used to validate existing and novel 12-lead ECG criteria. METHODS: One hundred fifty-one consecutive patients with their first hospital admission for chest pain underwent ceMRI. The 116 patients without ECG confounding factors were included in this study, and AMI was confirmed in 58 (50%). The admission ECG was evaluated on the basis of the lead distribution of ST-segment deviation according to current American College of Cardiology/European Society of Cardiology (ACC/ESC) guidelines. RESULTS: A sensitivity of 50% and specificity of 97% for AMI were achieved with the currently applied ST-segment elevation criteria. Consideration of ST-segment depression in addition to elevation increased sensitivity for detection of AMI from 50% to 84% (p < 0.0001) but only decreased specificity from 97% to 93% (p = 0.50). There were no significant differences in AMI location or size between patients meeting the 12-lead ACC/ESC ST-segment elevation criteria and those only meeting the ST-segment depression criteria. CONCLUSIONS: In patients admitted to hospital with possible AMI, the consideration of both ST-segment elevation and depression in the standard 12 lead-ECG recording significantly increases the sensitivity for the detection of AMI with only a slight decrease in the specificity.
Thomas N Martin; Bjoern A Groenning; Heather M Murray; Tracey Steedman; John E Foster; Alex T Elliot; Henry J Dargie; Ronald H Selvester; Olle Pahlm; Galen S Wagner
Publication Detail:
Type:  Controlled Clinical Trial; Journal Article     Date:  2007-08-24
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  50     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-09-10     Completed Date:  2007-09-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1021-8     Citation Subset:  AIM; IM    
Glasgow Cardiac Magnetic Resonance Unit, Glasgow University, Glasgow, United Kingdom.
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MeSH Terms
Biological Markers / blood
Contrast Media
Early Diagnosis
Gadolinium DTPA / diagnostic use
Magnetic Resonance Imaging
Middle Aged
Myocardial Infarction / blood,  diagnosis*,  physiopathology*
Predictive Value of Tests
Reg. No./Substance:
0/Biological Markers; 0/Contrast Media; 80529-93-7/Gadolinium DTPA

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