Prehospital 80-LAD mapping: Does it add significantly to the diagnosis of acute coronary syndromes?☆
Section snippets
Patient recruitment
Patients were recruited consecutively between January 2002 and January 2004 as they presented to the physician-manned mobile coronary care unit. Patients were enrolled over 24 hours if they presented with ischemic type chest pain of <12 hours duration regardless of the initial 12-lead ECG. All patients had a 12-lead ECG and BSM performed at presentation outside the hospital together with initial and 12-hour cardiac Troponin-I (cTnI) (January 2002-August 2003) or cardiac Troponin-T (cTnT)
Results
Between January 2002 and 2004, 294 patients were recruited. The mean age of the patients was 64 ± 12 years and 209 were male (71%). A past history of hypertension was present in 122 (42%), hypercholesterolemia (defined as total cholesterol >193 mg/dL) in 120 (41%), smokers in 97 (33%) and diabetes mellitus in 44 (15%). Acute MI occurred in 182/294 (62%) based on cTnT or cTnI.
Discussion
In the immediate triage and infarct recognition of ACS patients, ECG technology, which is still core to the diagnosis, has lagged behind relative to other diagnostic methods. Echocardiography, radionuclide imaging and even MRI have all added value in ACS patients particularly those with non-diagnostic ECG’s 1, 24, 25 but these tests are not available routinely in all emergency departments and not in the pre-hospital setting. Current markers of myocardial necrosis, though highly sensitive and
Conclusion
Despite addition of QRST variables to the 12-lead ECG (ST-elevation), the BSM is superior in predicting acute MI prehospital and thus adds significantly to the diagnosis and management of ACS. Because rapid diagnosis and treatment is the cornerstone for patients both with STEMI and NSTEMI, electrocardiographic methods such as body surface mapping which detect myocardial injury early are more useful for guiding the appropriate early use of treatment at first presentation at a time when the
References (31)
- et al.
The prehospital electrocardiogram in acute myocardial infarctionIs its full potential being realized?
JACC
(1997) - et al.
Utility of the prehospital electrocardiogram in diagnosing acute coronary syndromesThe myocardial infarction triage and intervention (MITI) project
J Am Coll Cardiol
(1998) - et al.
Comparison of the 80-lead body surface map to physician and to 12-lead electrocardiogram in detection of acute myocardial infarction
Am J Cardiol
(2003) - et al.
Quantitative analysis of the admission electrocardiogram identifies patients with unstable coronary artery disease who benefit the most from early invasive treatment
J Am Coll Cardiol
(2003) - et al.
Prognostic significance of ST segment depression in lateral leads I, aVL, V5 and V6 on the admission electrocardiogram in patients with a first acute myocardial infarction without ST segment elevation
J Am Coll Cardiol
(2000) - et al.
Electrocardiographic manifestationsacute posterior wall myocardial infarction
J Emerg Med
(2001) - et al.
Usefulness of ST elevation II/III Ratio and ST deviation in lead I for identifying the culprit artery in inferior wall acute myocardial infarction
Am J Cardiol
(2000) - et al.
New electrocardiographic criteria for predicting either the right or left circumflex artery as the culprit coronary artery in inferior wall acute myocardial infarction
Am J Cardiol
(1997) - et al.
Electrocardiographic diagnosis of acute myocardial infarctionCurrent concepts for the clinician
Am Heart J
(2001)
Clinical value of acute rest technetium-99m tetrofosmin tomographic myocardial perfusion imaging in patients with acute chest pain and nondiagnostic electrocardiograms
J Am Coll Cardiol
Reciprocal ST segment depressionimpact on the electrocardiographic diagnosis of ST segment elevation acute myocardial infarction
Am J Emerg Med
Clinical implications of isolated T wave inversion in adultselectrocardiographic differentiation of the underlying causes of this phenomenon
J Am Coll Cardiol
Do patients with left circumflex coronary artery-related acute myocardial infarction without ST-segment elevation benefit from reperfusion therapy?
Am J Cardiol
Acute myocardial infarction with isolated ST-segment elevation in posterior chest leads V7-9“Hidden” ST-segment elevations revealing acute posterior infarction
J Am Coll Cardiol
Cited by (27)
Review of current ECG consumer electronics (pros and cons)
2023, Journal of ElectrocardiologyCitation Excerpt :Nonetheless, the 6 limb leads of an ECG are also not sufficient to reliably detect infarction. Only approximately 27% - 57% of myocardial infarctions are detectable even by standard 12‑lead ECGs ([7–9]), and those percentages fall even further when only the limb leads are available. In addition to serial 12‑lead ECG recordings, specific cardiac blood markers and evaluation of patient history, including the presence of ischemic-type chest pain lasting for >20 min, are also important for infarct diagnosis.
Prehospital factors associated with an acute life-threatening condition in non-traumatic chest pain patients - A systematic revie
2016, International Journal of CardiologyCitation Excerpt :In these cases the articles judged to be the most relevant were included, considering the objective of this review (Fig. 1). In total 10 studies were included, of which seven [18–24] evaluated potential risk factors and three [25–27] evaluated the prehospital diagnostic accuracy of biochemical cardiac markers. In total 56 factors (biochemical cardiac markers excluded) were studied in the articles included (Table 2), and 20 of these were studied in two or more studies (Table 3).
Telecardiology: Past, present and future
2013, Revista Espanola de CardiologiaECG-based signal analysis technologies for evaluating patients with acute coronary syndrome: A systematic review
2013, Journal of ElectrocardiologyCitation Excerpt :Of note, funding or material support for the PRIME ECG studies appeared to be linked to the manufacturer for all included studies of this device. We identified 10 studies represented by 13 articles that evaluated the PRIME ECG BSM device4–16 (Appendix). Of the 10 studies, 6 were conducted by a research group in Belfast, Northern Ireland.4–9
Future Developments in Chest Pain Diagnosis and Management
2010, Medical Clinics of North AmericaCitation Excerpt :In particular, BSM can differentiate a group of patients who in fact have ST elevation on BSM, who theoretically might therefore benefit from early reperfusion therapy.19,20 One BSM trial has also shown the ability to detect AMI prehospital.21 However, early detection of AMI with BSM comes at a cost of a lower specificity and higher false-positive results compared with the standard ECG.22
Performance of a body surface mapping system using emergency physician real-time interpretation
2009, American Journal of Emergency Medicine
- ☆
This study was supported by research fellowships from the Research and Development of the Northern Ireland Health and Social services Agency and the Frances and Augustus Newman Foundation.