Performance of ST and ventricular gradient difference vectors in electrocardiographic detection of acute myocardial ischemia

• Published in: Journal of electrocardiology Vol. 48; no. 4; pp. 498 - 504
• Main Authors: Treskes, Roderick W., BSc, Ter Haar, C. Cato, BSc, Man, Sumche, MD, De Jongh, Marjolein C., BSc, Maan, Arie C., PhD, Wolterbeek, Ron, MSc, Schalij, Martin J., MD, PhD, Wagner, Galen S., MD, Swenne, Cees A., PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2015
• Subjects: Acute coronary syndrome; Algorithms; Cardiovascular; Coronary Stenosis - complications; Coronary Stenosis - diagnosis; Diagnosis, Computer-Assisted - methods; Electrocardiography - methods; Female; Humans; Ischemia; Male; Middle Aged; Myocardial Ischemia - diagnosis; Myocardial Ischemia - etiology; Reproducibility of Results; Sensitivity and Specificity; Serial ECG analysis; Vectorcardiogram; Ischemia; Acute coronary syndrome; Serial ECG analysis; Vectorcardiogram
• ISSN: 0022-0736; 1532-8430
• DOI: 10.1016/j.jelectrocard.2015.04.016

Abstract Introduction Serial analysis could improve ECG diagnosis of myocardial ischemia caused by acute coronary occlusion. Methods We analyzed ECG pairs of 84 cases and 398 controls. In case-patients, who underwent elective percutaneous coronary intervention, ischemic ECGs during balloon occlusion were compared with preceding non-ischemic ECGs. In control-patients, two elective non-ischemic ECGs were compared. In each ECG the ST vector at the J point and the ventricular gradient (VG) vector was computed, after which difference vectors ΔST and ΔVG were computed within patients. Finally, receiver operating characteristic analysis was done. Results Areas under the curve were 0.906 ( P < 0.001; CI 0.862–0.949; SE 0.022) for ΔST and 0.880 ( P < 0.001; CI 0.833–0.926; SE 0.024) for ΔVG. Sensitivity and specificity of conventional ST-elevation myocardial infarction (STEMI) criteria were 70.2% and 89.1%, respectively. At matched serial analysis specificity and STEMI specificity, serial analysis sensitivity was 78.6% for ΔST and 71.4% for ΔVG (not significantly different from STEMI sensitivity). At matched serial analysis sensitivity and STEMI sensitivity, serial analysis specificity was 96.5% for ΔST and 89.3% for ΔVG; ΔST and STEMI specificities differed significantly ( P < 0.001). Conclusion Detection of acute myocardial ischemia by serial ECG analysis of ST and VG vectors has equal or even superior performance than the STEMI criteria. This concept should be further evaluated in triage ECGs of patients suspected from having acute myocardial ischemia.