Does routine use of the 15-lead ECG improve the diagnosis of acute myocardial infarction in patients with chest pain?
OBJECTIVE
It has been suggested that the use of additional electrocardiogram leads might improve the diagnostic sensitivity of this test, thus potentially expanding eligibility for thrombolysis for patients suffering myocardial infarction. The aims of this study were to evaluate the role of the 15-lead electrocardiogram in the emergency department chest pain population and to determine whether the routine use of the extra leads expands the group of patients eligible to receive thrombolysis.


METHODS
Blinded, individual and independent analysis by two emergency physicians of paired 12- and 15-lead electrocardiograms from adult patients with a primary complaint of chest pain. The main outcome measure was the diagnosis of myocardial infarction eligible for thrombolysis. Data were analysed using descriptive statistics and kappa statistics for agreement between raters.


RESULTS
540 electrocardiograms (270 sets) were analysed. Myocardial infarction qualifying for thrombolysis was identified (by consensus) in 21 cases. In no case did the 15-lead electrocardiograph identify a myocardial infarction qualifying for thrombolysis that was not identified on the 12-lead electrocardiogram.


CONCLUSIONS
In this study, the 15-lead electrocardiogram did not increase the number of thrombolysis-eligible myocardial infarctions identified when compared with the 12-lead electrocardiogram. This study is limited by the small patient sample size, and a large multicentre trial is recommended to compare the 12- and 15-lead electrocardiograms in the emergency department population where the incidence of posterior and right-sided myocardial infarction is ultimately known.
Rosengarten
P
P
Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia. pamela.rosengarten@southernhealth.org.au
Kelly
A M
AM
Dixon
D
D
D000328:Adult; D002637:Chest Pain / Q000209:etiology*; D004562:Electrocardiography / Q000295:instrumentation*; D004566:Electrodes; D004630:Emergencies; D004867:Equipment Design; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis*; D011446:Prospective Studies