Acute detection of ST-elevation myocardial infarction missed on standard 12-Lead ECG with a novel 80-lead real-time digital body surface map: primary results from the multicenter OCCULT MI trial.
OBJECTIVE
Although 80-lead ECG body surface mapping is more sensitive for ST-elevation myocardial infarction (STEMI) than the 12-lead ECG, its clinical utility in chest pain in the emergency department (ED) has not been studied. We sought to determine the prevalence, clinical care patterns, and clinical outcomes of patients with STEMI identified on 80-lead but not on 12-lead (80-lead-only STEMI).


METHODS
The Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction trial was a multicenter prospective observational study of moderate- to high-risk chest pain patients presenting to the ED. Patients received simultaneous 12-lead and 80-lead ECGs as part of their initial evaluation and were treated according to the standard of care, with clinicians blinded to the 80-lead results. The primary outcome of the trial was door-to-sheath time in patients with 80-lead-only STEMI versus patients with STEMI identified by 12-lead alone (12-lead STEMI). Secondary outcomes included angiographic and clinical outcomes at 30 days.


RESULTS
One thousand eight hundred thirty patients were evaluated, 91 had a discharge diagnosis of 12-lead STEMI, and 25 patients met criteria for 80-lead-only STEMI. Eighty-four of the 91 12-lead STEMI patients underwent cardiac catheterization, with a median door-to-sheath time of 54 minutes, versus 14 of the 25 80-lead-only STEMI patients, with a door-to-sheath time of 1,002 minutes (estimated treatment difference in median=881; 95% confidence interval 181 to 1,079 minutes). Clinical outcomes and revascularization rates, however, were similar between 80-lead-only STEMI and 12-lead STEMI patients.


CONCLUSIONS
The 80-lead ECG provides an incremental 27.5% increase in STEMI detection versus the 12-lead. Patients with 80-lead-only STEMI have adverse outcomes similar to those of 12-lead STEMI patients but are treated with delayed or conservative invasive strategies.
Hoekstra
James W
JW
Department of Emergency Medicine, Wake Forest University Health Sciences, Winston-Salem, NC 27023, USA. jhoekstr@wfubmc.edu
O'Neill
Brian J
BJ
Pride
Yuri B
YB
Lefebvre
Cedric
C
Diercks
Deborah B
DB
Peacock
W Frank
WF
Fermann
Gregory J
GJ
Gibson
C Michael
CM
Pinto
Duane
D
Giglio
Jim
J
Chandra
Abhinav
A
Cairns
Charles B
CB
Konstam
Marvin A
MA
Massaro
Joe
J
Krucoff
Mitchell
M
D054058:Acute Coronary Syndrome / Q000175:diagnosis; D000368:Aged; D018780:Body Surface Potential Mapping; D003951:Diagnostic Errors / Q000517:prevention & control; D004311:Double-Blind Method; D004562:Electrocardiography / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis