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CLINICAL RESEARCH: CORONARY ARTERY DISEASE

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

Thomas N. Martin, MD^_*,_*, Bjoern A. Groenning, MD^_*, Heather M. Murray, MSc, Tracey Steedman, BSc^_*, John E. Foster, PhD^_*, Alex T. Elliot, PhD^_*, Henry J. Dargie, MD^_*, Ronald H. Selvester, MD^,1, Olle Pahlm, MD, PhD and Galen S. Wagner, MD^||,2

^_* Glasgow Cardiac Magnetic Resonance Unit, Glasgow University, Glasgow, United Kingdom
Robertson Centre for Biostatistics, Glasgow University, Glasgow, United Kingdom
Memorial Hospital, Long Beach, California
Department of Clinical Physiology, Lund University Hospital, Lund, Sweden
^|| Duke University Medical Center, Durham, North Carolina.

Manuscript received October 4, 2006; revised manuscript received March 6, 2007, accepted April 3, 2007.

^_* Reprint requests and correspondence: Dr. Thomas N. Martin, Western Infirmary, Dumbarton Road, Glasgow, Strathclyde G206DW, Scotland. (Email: t.martin{at}clinmed.gla.ac.uk).

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.

Abbreviations and Acronyms   ACC = American College of Cardiology   ACS = acute coronary syndrome   AMI = acute myocardial infarction   ceMRI = contrast-enhanced magnetic resonance imaging   ECG = electrocardiogram/electrocardiographic   ESC = European Society of Cardiology   LAD = left anterior descending coronary artery   LCx = left circumflex coronary artery   LV = left ventricle/ventricular   LVEF = left ventricular ejection fraction   MVO = microvascular obstruction   NSTEMI = non–ST-segment elevation myocardial infarction   RCA = right coronary artery   STEMI = ST-segment elevation myocardial infarction

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