title: 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.
abstract: 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%.
authors.affiliation: Department of Emergency Medicine, Fairview Southdale Hospital, Edina, MN.
authors.forename: D L
authors.initials: DL
authors.lastname: Justis
authors.forename: W T
authors.initials: WT
authors.lastname: Hession
mesh_terms: 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
chemical_list: D007527:Isoenzymes; D003402:Creatine Kinase; D010959:Tissue Plasminogen Activator