PMID- 30177366
OWN - NLM
STAT- MEDLINE
DCOM- 20191014
LR  - 20220408
IS  - 1532-8430 (Electronic)
IS  - 0022-0736 (Linking)
VI  - 51
IP  - 6S
DP  - 2018 Nov-Dec
TI  - Criteria for ECG detection of acute myocardial ischemia: Sensitivity versus 
      specificity.
PG  - S12-S17
LID - S0022-0736(18)30339-X [pii]
LID - 10.1016/j.jelectrocard.2018.08.018 [doi]
AB  - BACKGROUND: Criteria for electrocardiographic detection of acute myocardial 
      ischemia recommended by the Consensus Document of ESC/ACCF/AHA/WHF consist of two 
      parts: The ST elevation myocardial infarction (STEMI) criteria based on ST 
      elevation (ST upward arrow) in 10 pairs of contiguous leads and the other on ST depression 
      (ST downward arrow) in the same 10 contiguous pairs. Our aim was to assess sensitivity (SE) and 
      specificity (SP) of these criteria-and to seek their possible improvements-in 
      three databases of 12‑lead ECGs. METHODS: We used (1) STAFF III data of 
      controlled ischemic episodes recorded from 99 patients (pts) during percutaneous 
      coronary intervention (PCI) involving either left anterior descending (LAD) 
      coronary artery, right coronary artery (RCA), or left circumflex (LCx) coronary 
      artery. (2) Data from the University of Glasgow for 58 pts with acute myocardial 
      infarction (AMI) and 58 pts without AMI, as confirmed by MRI. (3) Data from Lund 
      University retrieved from a centralized ECG management system for 100 pts with 
      various pathological ST changes-other than acute coronary occlusion-including 
      ventricular pre-excitation, acute pericarditis, early repolarization syndrome, 
      left ventricular hypertrophy, and left bundle branch block. ST measurements at 
      J-point in ECGs of all 315 pts were obtained automatically on the averaged beat 
      with manual review and the recommended criteria as well as their proposed 
      modifications, were applied. Performance measures included SE, SP, positive 
      predictive value (PPV), and benefit-to-harm ratio (BHR), defined as the ratio of 
      true-positive vs. false-positive detections. RESULTS: We found that the SE of 
      widely-used STEMI criteria can be indeed improved by the additional ST downward arrow criteria, 
      but at the cost of markedly decreased SP. In contrast, using ST upward arrow in only 3 
      additional contiguous pairs of leads (STEMI13) can boost SE without any loss of 
      SP. In the STAFF III database, SE/SP/PPV were 56/98/97% for the STEMI, 79/79/79% 
      for the STEMI with added ST downward arrow and 67/97/96% for the STEMI13. In the Glasgow 
      database, corresponding SE/SP/PPV were 43/98/96%, 84/90/89%, and 55/98/97%. For 
      the Lund database, SP was 56% for the STEMI, 24% for the STEMI with ST downward arrow, and 56% 
      for the STEMI13. CONCLUSION: Current recommended criteria for detecting acute 
      myocardial ischemia, involving ST downward arrow, boost SE of widely-used STEMI criteria, at 
      the cost of SP. To keep the SP high, we propose either the adjustment of 
      threshold for the added ST downward arrow criteria or a selective use of ST downward arrow only in contiguous 
      leads V2 and V3 plus ST upward arrow in lead pairs (aVL, -III) and (III, -aVL).
CI  - Copyright (c) 2018 Elsevier Inc. All rights reserved.
FAU - Wang, John J
AU  - Wang JJ
AD  - Philips Healthcare, Andover, MA, USA. Electronic address: 
      john.j.wang@philips.com.
FAU - Pahlm, Olle
AU  - Pahlm O
AD  - Department of Clinical Sciences, Lund University, Lund, Sweden.
FAU - Warren, James W
AU  - Warren JW
AD  - Dalhousie University, Halifax, NS, Canada.
FAU - Sapp, John L
AU  - Sapp JL
AD  - Dalhousie University, Halifax, NS, Canada.
FAU - Horacek, B Milan
AU  - Horacek BM
AD  - Dalhousie University, Halifax, NS, Canada.
LA  - eng
GR  - CIHR/Canada
PT  - Journal Article
DEP - 20180813
PL  - United States
TA  - J Electrocardiol
JT  - Journal of electrocardiology
JID - 0153605
SB  - IM
MH  - Consensus
MH  - Diagnosis, Computer-Assisted
MH  - Diagnosis, Differential
MH  - *Electrocardiography
MH  - Humans
MH  - Myocardial Ischemia/*diagnosis/surgery
MH  - Percutaneous Coronary Intervention
MH  - ST Elevation Myocardial Infarction/diagnosis/surgery
MH  - Sensitivity and Specificity
OTO - NOTNLM
OT  - *Acute ischemia detection
OT  - *Electrocardiographic monitoring
OT  - *Non-ischemic ST-segment deviation
OT  - *STEMI criteria
EDAT- 2018/09/05 06:00
MHDA- 2019/10/15 06:00
CRDT- 2018/09/05 06:00
PHST- 2018/05/15 00:00 [received]
PHST- 2018/08/05 00:00 [revised]
PHST- 2018/08/12 00:00 [accepted]
PHST- 2018/09/05 06:00 [pubmed]
PHST- 2019/10/15 06:00 [medline]
PHST- 2018/09/05 06:00 [entrez]
AID - S0022-0736(18)30339-X [pii]
AID - 10.1016/j.jelectrocard.2018.08.018 [doi]
PST - ppublish
SO  - J Electrocardiol. 2018 Nov-Dec;51(6S):S12-S17. doi: 
      10.1016/j.jelectrocard.2018.08.018. Epub 2018 Aug 13.