Accuracy of 22-lead ECG analysis for diagnosis of acute myocardial infarction and coronary artery disease in the emergency department: a comparison with 12-lead ECG.
OBJECTIVE
To compare a new 22-lead ECG with the 12-lead ECG for diagnosis of acute myocardial infarction (AMI).


METHODS
Prospective study of all consenting patients presenting to the emergency department with chest pain.


METHODS
Urban hospital ED.


METHODS
163 patients admitted with a cardiac-related diagnosis and complete data sets of 22- and 12-lead ECG results and creatine kinase-MB analysis.


METHODS
Patient care and existing protocols were unaltered, with the exception of including the new 22-lead ECG.


RESULTS
Forty-one of 163 patients had an AMI as defined by creatine kinase-MB analysis. The 22-lead ECG provided a statistically significant improvement in sensitivity (83%) for AMI diagnosis over the 12-lead ECG (51%) with specificities of 76% and 99%, respectively.


CONCLUSIONS
When combined with clinical judgment, the 22-lead ECG could provide a 97.6% sensitivity for AMI diagnosis while reducing unnecessary admissions for "rule-out MI" by 69%.
Justis
D L
DL
Department of Emergency Medicine, Fairview Southdale Hospital, Edina, MN.
Hession
W T
WT
D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography / Q000295:instrumentation* / Q000592:standards; D004566:Electrodes; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy / Q000201:enzymology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D007527:Isoenzymes; D003402:Creatine Kinase; D010959:Tissue Plasminogen Activator