Improved Acute Myocardial Ischemia Detection Using Vessel-Specific Leads (VSL) Derived from the 12-Lead ECG

Introduction: To further improve existing criteria recommended by ACC/ESC for identifying patients with ST elevation myocardial infarction (STEMI) from the 12-lead ECG, we have developed new criteria based on ST-deviation calculated from three “optimal” vessel-specific leads (VSLs) derived from the 12-lead ECG.
Method: The performance of the VSLs vs. STEMI criteria was evaluated using two independent datasets: the Glasgow dataset included admission ECGs of 116 chest-pain patients with confirmed AMI in 58 patients (50%) and the Lund dataset included ECGs of 100 patients with various causes of pathological ST-deviation, other than acute coronary occlusion: ventricular pre-excitation (n=12), acute pericarditis (n=26), ERS (n=14), LVH (n=26), and LBBB (n=22). Sensitivity (SE) and specificity (SP) were calculated and used as the performance measures for comparison.
Results: For the Glasgow dataset, STEMI criteria yielded SE/SP of 43/98%, whereas the VSLs improved SE/SP to 60/98%. The most significant increase in diagnostic performance appeared in patients with LCx occlusion (n=13): SE improved from 31% to 69%. For the Lund dataset, SP test results using the STEMI and VSLs criteria were 100%/92%, 4%/88%, 29%/100%, 100%/96%, and 64%/68% for the five subgroups: pre-excitation, pericarditis, ERS, LVH, and LBBB, respectively. For the whole group, SP results were 57% for the STEMI criteria and 88% for the VSLs method (p < 0.001).
Conclusion: Based on these results we conclude that the new VSLs method has the potential to outperform the existing STEMI criteria in identifying patients who should receive emergent reperfusion therapy. This finding needs to be corroborated further on a larger study population.