Prehospital 80-LAD mapping: does it add significantly to the diagnosis of acute coronary syndromes?
Early detection of acute myocardial infarction (MI) is vital in the management of acute coronary syndromes (ACS). Hence we compared the diagnostic capability of the standard 12-lead electrocardiogram (ECG) with the 80-lead ECG body surface map (BSM) prehospital.


METHODS
Consecutive patients (n = 294) presenting prehospital with ischemic type chest pain were included. All had an ECG and BSM pretreatment and a baseline and 12-hour cardiac troponin-T or I (cTnT or cTnI). Acute MI was defined as cTnT > 0.09 or cTnI > 0.1 ng/mL. Acute MI on the BSM was defined as ST elevation measured at the J-point, > or = 1 mm inferior/right ventricular/high right anterior/lateral regions, > or = 2 mm anterior region, > or = 0.5 mm posterior region.


RESULTS
Acute MI occurred in 182/294 (62%) based on cTnT or I. ST elevation on the standard ECG predicted acute MI in 103 (sensitivity 57%, specificity 94%; c-statistic 0.73). The optimal model for the standard ECG included ST elevation, summed ST depression and past history of MI (c-statistic 0.82; Chi-square (Wald) 120.7, 3df). The BSM predicted acute MI in 146 (sensitivity 80%, specificity 92%; c-statistic 0.86). The optimal model for the BSM included BSM criteria for acute MI and past history of MI (c-statistic 0.91; Chi-square (Wald) 180.3, 2df).


CONCLUSIONS
The 80-lead BSM is superior to the standard 12-lead ECG in predicting acute MI prehospital.
Owens
Colum G
CG
Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast, Northern, Ireland. columowens@yahoo.co.uk
McClelland
Anthony J J
AJ
Walsh
Simon J
SJ
Smith
Bernadette A
BA
Tomlin
Audrey
A
Riddell
John W
JW
Stevenson
Michael
M
Adgey
A A Jennifer
AA
D000787:Angina Pectoris / Q000175:diagnosis; D018780:Body Surface Potential Mapping / Q000379:methods*; D003327:Coronary Disease / Q000175:diagnosis*; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D004632:Emergency Medical Services; D005260:Female; D005544:Forecasting; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology; D010496:Pericardium / Q000503:physiopathology; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000032:analysis; D020107:Troponin T / Q000032:analysis
D019210:Troponin I; D020107:Troponin T