title: Prehospital 80-LAD mapping: does it add significantly to the diagnosis of acute coronary syndromes?
abstract: 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.
authors.affiliation: Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast, Northern, Ireland. columowens@yahoo.co.uk
authors.forename: Colum G
authors.initials: CG
authors.lastname: Owens
authors.forename: Anthony J J
authors.initials: AJ
authors.lastname: McClelland
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Walsh
authors.forename: Bernadette A
authors.initials: BA
authors.lastname: Smith
authors.forename: Audrey
authors.initials: A
authors.lastname: Tomlin
authors.forename: John W
authors.initials: JW
authors.lastname: Riddell
authors.forename: Michael
authors.initials: M
authors.lastname: Stevenson
authors.forename: A A Jennifer
authors.initials: AA
authors.lastname: Adgey
mesh_terms: 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
chemical_list: D019210:Troponin I; D020107:Troponin T