BACKGROUND: Clinical trials in prehospital electrocardiography have focused primarily on ST elevation myocardial infarction (STEMI). The aims of this study were to determine, in patients presenting to the emergency department with acute coronary syndrome (ACS), the (1) relative frequency of various ACS types and (2) sensitivity of conventional ST-T criteria for diagnosing ischemia in non-STEMI or unstable angina. METHODS: A secondary analysis was conducted using data from prospective trials involving 12-lead ST monitoring. RESULTS: Of 968 patients with ACS, 120 (12%) were STEMI, 289 (30%) were non-STEMI, and 559 (58%) were unstable angina. Conventional electrocardiogram (ECG) criteria were insensitive (sensitivity, 20%) for detecting ischemia in patients with non-STEMI or unstable angina. There was no ischemia on the initial ECG in 85 patients who had subsequent events with ST monitoring. CONCLUSION: Non-STEMI and unstable angina are the most prevalent types of ACS. The initial ECG is insensitive for detecting ischemia in this population. Transient myocardial ischemia detected with ST monitoring commonly occurs in patients without ischemia on the initial ECG. ST monitoring should be considered in designing prehospital ECG systems.
BACKGROUND: Clinical trials in prehospital electrocardiography have focused primarily on ST elevation myocardial infarction (STEMI). The aims of this study were to determine, in patients presenting to the emergency department with acute coronary syndrome (ACS), the (1) relative frequency of various ACS types and (2) sensitivity of conventional ST-T criteria for diagnosing ischemia in non-STEMI or unstable angina. METHODS: A secondary analysis was conducted using data from prospective trials involving 12-lead ST monitoring. RESULTS: Of 968 patients with ACS, 120 (12%) were STEMI, 289 (30%) were non-STEMI, and 559 (58%) were unstable angina. Conventional electrocardiogram (ECG) criteria were insensitive (sensitivity, 20%) for detecting ischemia in patients with non-STEMI or unstable angina. There was no ischemia on the initial ECG in 85 patients who had subsequent events with ST monitoring. CONCLUSION: Non-STEMI and unstable angina are the most prevalent types of ACS. The initial ECG is insensitive for detecting ischemia in this population. Transient myocardial ischemia detected with ST monitoring commonly occurs in patients without ischemia on the initial ECG. ST monitoring should be considered in designing prehospital ECG systems.
Authors: Thomas Huebner; W M Michael Schuepbach; Andrea Seeck; Ernst Sanz; Bernhard Meier; Andreas Voss; Roland Pilgram Journal: Med Biol Eng Comput Date: 2010-03-19 Impact factor: 2.602
Authors: Stefan Weber; Ralf Birkemeyer; Dominik Schultes; Walter Grewenig; Thomas Huebner Journal: Ann Noninvasive Electrocardiol Date: 2014-03-10 Impact factor: 1.468
Authors: Thomas Huebner; Matthias Goernig; Michael Schuepbach; Ernst Sanz; Roland Pilgram; Andrea Seeck; Andreas Voss Journal: Ger Med Sci Date: 2010-10-11