title: ST-segment deviation analysis of the admission 12-lead electrocardiogram as an aid to early diagnosis of acute myocardial infarction with a cardiac magnetic resonance imaging gold standard.
abstract: OBJECTIVE
  The purpose of this study was to validate existing 12-lead electrocardiographic (ECG) ST-segment elevation myocardial infarction (STEMI) criteria in the diagnosis of acute myocardial infarction (AMI) and the application of similar ST-segment depression (STEMI-equivalent) criteria with contrast-enhanced cardiac magnetic resonance imaging (ceMRI) as the diagnostic gold standard.
  
  
  BACKGROUND
  The admission ECG is the cornerstone in the diagnosis of AMI, and ceMRI is a new diagnostic gold standard that can be used to validate existing and novel 12-lead ECG criteria.
  
  
  METHODS
  One hundred fifty-one consecutive patients with their first hospital admission for chest pain underwent ceMRI. The 116 patients without ECG confounding factors were included in this study, and AMI was confirmed in 58 (50%). The admission ECG was evaluated on the basis of the lead distribution of ST-segment deviation according to current American College of Cardiology/European Society of Cardiology (ACC/ESC) guidelines.
  
  
  RESULTS
  A sensitivity of 50% and specificity of 97% for AMI were achieved with the currently applied ST-segment elevation criteria. Consideration of ST-segment depression in addition to elevation increased sensitivity for detection of AMI from 50% to 84% (p < 0.0001) but only decreased specificity from 97% to 93% (p = 0.50). There were no significant differences in AMI location or size between patients meeting the 12-lead ACC/ESC ST-segment elevation criteria and those only meeting the ST-segment depression criteria.
  
  
  CONCLUSIONS
  In patients admitted to hospital with possible AMI, the consideration of both ST-segment elevation and depression in the standard 12 lead-ECG recording significantly increases the sensitivity for the detection of AMI with only a slight decrease in the specificity.
authors.affiliation: Glasgow Cardiac Magnetic Resonance Unit, Glasgow University, Glasgow, United Kingdom. t.martin@clinmed.gla.ac.uk
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Martin
authors.forename: Bjoern A
authors.initials: BA
authors.lastname: Groenning
authors.forename: Heather M
authors.initials: HM
authors.lastname: Murray
authors.forename: Tracey
authors.initials: T
authors.lastname: Steedman
authors.forename: John E
authors.initials: JE
authors.lastname: Foster
authors.forename: Alex T
authors.initials: AT
authors.lastname: Elliot
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Dargie
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Selvester
authors.forename: Olle
authors.initials: O
authors.lastname: Pahlm
authors.forename: Galen S
authors.initials: GS
authors.lastname: Wagner
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media; D042241:Early Diagnosis; D004562:Electrocardiography; D005260:Female; D019786:Gadolinium DTPA; D006760:Hospitalization; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology*; D011237:Predictive Value of Tests