Comparison of usefulness of computer assisted continuous 48-h 3-lead with 12-lead ECG ischaemia monitoring for detection and quantitation of ischaemia in patients with unstable angina

• Published in: European heart journal Vol. 18; no. 6; pp. 931 - 940
• Main Authors: Klootwijk, P., Meij, S., Es, G. A. v., Müller, E. J., Umans, V. A. W. M., Lenderink, T., Simoons, M. L.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.06.1997
• Subjects: Angina, Unstable - complications; Biological and medical sciences; Cardiology. Vascular system; Chi-Square Distribution; Coronary heart disease; Diagnosis, Computer-Assisted; ECG leads; Electrocardiography - instrumentation; Electrocardiography - methods; Female; Heart; Humans; Male; Medical sciences; Monitoring, Physiologic - methods; Myocardial Ischemia - diagnosis; Myocardial Ischemia - etiology; Myocardial Ischemia - physiopathology; Sensitivity and Specificity; ST monitoring; unstable angina; Human; ST interval; Cardiovascular disease; Exploration; Coronary heart disease; Myocardial disease; Vascular disease; Electrodiagnosis; Ischemia; Follow up study; Electrocardiography; Myocardium; Ambulatory; Technique; Variant angina; Computer aid; Comparative study; Monitoring
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/oxfordjournals.eurheartj.a015381

Aims The selection of ECG leads used for ST monitoring may influence detection and quantitation of ischaemia. Methods We compared on-line continuous 48-h 12-lead against 3-lead ST monitoring in 130 unstable angina patients (Mortara, ELI-100). Onset and offset of ST episodes were defined by the lead with the first ≥100 μV ST change relative to baseline and the lead with the latest return to baseline ST level, respectively. ST episodes were calculated for 12 leads and 3 leads (V2, V5, III) separately. Results ST episodes were detected in 88 patients (77%) by 12-lead and in 71 patients (62%) by 3-lead ST monitoring (P<0·02). The median number (25, 75%) of episodes/patient was 1 (0, 3) for 3-lead and 2 (1, 6) for 12-lead (p<0·0001). The total duration of ischaemia detected during 12-lead far exceeded 3-lead monitoring: 12·3 (1, 58·2) and 1·7 (0, 23·3) min respectively (p<0·0001). The probability of recurrent ischaemia declined most during the first 24 h of monitoring. After a period without ST changes of 1, 12, 24 and 36 h, the probabilities of recurrent ischaemia were 63, 31, 14 and 9%, respectively. Conclusions Continuous 12-lead ST monitoring increases detection rate and duration of ST episodes compared to 3-lead ST monitoring. The use of continuous 12-lead ECG monitoring devices on emergency wards and coronary care units is recommended.