title: Cardiogoniometry as a diagnostic tool in patients with acute coronary syndromes: results of the CGM@ACS trial.
abstract: BACKGROUND
  Cardiogoniometry (CGM) is a novel electrocardiac method utilising computer-assisted three-dimensional information on cardiac potentials.
  
  
  OBJECTIVE
  To investigate the potential of CGM in discriminating non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and relevant coronary stenosis upon hospital admission by prospectively comparing its sensitivity, specificity and accuracy against those of a single troponin test and a 12-lead ECG performed on admission
  
  
  METHODS
  A multicenter prospective observational trial.
  
  
  METHODS
  Eight interventional cardiac centres in Germany.
  
  
  METHODS
  A cohort of 216 patients (mean age 67 years, 34.7 % female) who presented with acute chest pain or dyspnoea without ST-segment elevation and were scheduled for coronary angiography within 72 h of admission.
  
  
  METHODS
  Pre-angiography screening by CGM, troponin test, 12-lead ECG                                               MAIN OUTCOME MEASURES:                          ECG, troponin and CGM on admission compared with final diagnosis of NSTE-ACS or relevant diameter stenosis ≥70 % verified by an independent review board and an angiographic core laboratory.
  
  
  RESULTS
  NSTE-ACS was finally confirmed in 162 cases, whereas the remaining 54 cases without proof of NSTE-ACS served as controls. Diagnostic sensitivity for NSTE-ACS was 28, 50 and 69 % and specificity 78, 96 and 54 % for first ECG, serial troponin and first CGM, respectively. Accuracy was 40, 62 and 65 %. The sensitivity of the tests to detect relevant coronary stenosis (n = 126) was 32, 53 and 74 %, respectively. The sensitivity of CGM to detect NSTE-ACS (65 %) or relevant stenosis (71 %) was high even in patients with normal troponin and ECG.
  
  
  CONCLUSIONS
  CGM can detect NSTE-ACS at first medical contact. CGM in conjunction with traditional markers, 12-lead ECG and troponin may effectively aid early decision making in patients presenting with acute chest pain.
authors.affiliation: Herzzentrum, Segeberger Kliniken GmbH, Bad Segeberg, Germany. ralph.toelg@segebergerkliniken.de
authors.forename: Ralph
authors.initials: R
authors.lastname: Tölg
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Ralf
authors.initials: R
authors.lastname: Birkemeyer
authors.forename: Rainer
authors.initials: R
authors.lastname: Wessely
authors.forename: Holger
authors.initials: H
authors.lastname: Eggebrecht
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bocksch
authors.forename: Steffen
authors.initials: S
authors.lastname: Schneider
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
authors.forename: Christian
authors.initials: C
authors.lastname: Hamm
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000503:physiopathology; D000368:Aged; D002637:Chest Pain / Q000209:etiology; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D004417:Dyspnea / Q000209:etiology; D004562:Electrocardiography / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014336:Troponin / Q000378:metabolism*
chemical_list: D014336:Troponin