title: Pre-hospital body surface potential mapping improves early diagnosis of acute coronary artery occlusion in patients with ventricular fibrillation and cardiac arrest.
abstract: OBJECTIVE
  To determine whether 80-lead body surface potential mapping (BSPM) improves detection of acute coronary artery occlusion in patients presenting with out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation (VF) and who survived to reach hospital.
  
  
  RESULTS
  Of 645 consecutive patients with OHCA who were attended by the mobile coronary care unit, VF was the initial rhythm in 168 patients. Eighty patients survived initial resuscitation, 59 of these having had BSPM and 12-lead ECG post-return of spontaneous circulation (ROSC) and in 35 patients (age 69±13 yrs; 60% male) coronary angiography performed within 24 h post-ROSC. Of these, 26 (74%) patients had an acutely occluded coronary artery (TIMI flow grade [TFG] 0/1) at angiography. Twelve-lead ECG criteria showed ST-segment elevation (STE) myocardial infarction (STEMI) using Minnesota 9-2 criteria--sensitivity 19%, specificity 100%; ST-segment depression (STD) ≥0.05 mV in ≥2 contiguous leads--sensitivity 23%, specificity 89%; and, combination of STEMI or STD criteria--sensitivity 46%, specificity 100%. BSPM STE occurred in 23 (66%) patients. For the diagnosis of TFG 0/1 in a main coronary artery, BSPM STE had sensitivity 88% and specificity 100% (c-statistic 0.94), with STE occurring most commonly in either the posterior, right ventricular or high right anterior territories.
  
  
  CONCLUSIONS
  Among OHCA patients presenting with VF and who survived resuscitation to reach hospital, post-resuscitation BSPM STE identifies acute coronary occlusion with sensitivity 88% and specificity 100% (c-statistic 0.94).
authors.affiliation: The Heart Centre, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Daly
authors.forename: D D
authors.initials: DD
authors.lastname: Finlay
authors.forename: P J
authors.initials: PJ
authors.lastname: Scott
authors.forename: C D
authors.initials: CD
authors.lastname: Nugent
authors.forename: A A J
authors.initials: AA
authors.lastname: Adgey
authors.forename: M T
authors.initials: MT
authors.lastname: Harbinson
mesh_terms: D000368:Aged; D019540:Area Under Curve; D018780:Body Surface Potential Mapping; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000150:complications* / Q000175:diagnosis*; D042241:Early Diagnosis; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis* / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014693:Ventricular Fibrillation / Q000150:complications* / Q000175:diagnosis*