Value of Posterior and Right Ventricular Leads in Comparison to the Standard 12-Lead Electrocardiogram in Evaluation of ST-Segment Elevation in Suspected Acute Myocardial Infarction

In this multicenter prospective trial, we studied posterior (V7 to V9) and right ventricular (V4R to V6R) leads to assess their accuracy compared with standard 12-lead electrocardiograms (ECGs) for the diagnosis of acute myocardial infarction (AMI). Patients aged >34 years with suspected AMI rece...

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Bibliographic Details
Published in:The American journal of cardiology 1997-06, Vol.79 (12), p.1579-1585
Main Authors: Zalenski, Robert J, Rydman, Robert J, Sloan, Edward P, Hahn, Kenneth H, Cooke, David, Fagan, Joanne, Fligner, Denise J, Hessions, William, Justis, David, Kampe, Linda M, Shah, Shirish, Tucker, John, Zwicke, Diane
Format: Article
Language:English
Subjects:
Accuracy
Aged
Biological and medical sciences
Cardiology. Vascular system
Coronary heart disease
Electrocardiography
Electrocardiography - methods
Female
Heart
Heart attacks
Humans
Male
Medical sciences
Middle Aged
Multivariate Analysis
Myocardial Infarction - diagnosis
Predictive Value of Tests
Prospective Studies
Reproducibility of Results
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Summary:In this multicenter prospective trial, we studied posterior (V7 to V9) and right ventricular (V4R to V6R) leads to assess their accuracy compared with standard 12-lead electrocardiograms (ECGs) for the diagnosis of acute myocardial infarction (AMI). Patients aged >34 years with suspected AMI received posterior and right ventricular leads immediately after the initial 12-lead ECG. ST elevation of 0.1 mV in 2 leads was blindly determined and inter-rater reliability estimated. AMI was diagnosed by World Health Organization criteria. The diagnostic value of nonstandard leads was determined when 12-lead ST elevation was absent and present and multivariate stepwise regression analysis was also performed. Of 533 study patients, 64.7% (345 of 533) had AMI and 24.8% received thrombolytic therapy. Posterior and right ventricular leads increased sensitivity for AMI by 8.4% (p = 0.03) but decreased specificity by 7.0% (p = 0.06). The likelihood ratios of a positive test for 12, 12 + posterior, and 12 + right ventricular ECGs were 6.4, 5.6, and 4.5, respectively. Increased AMI rates (positive predictive values) were found when ST elevation was present on 6 nonstandard leads (69.1%), on 12 leads only (88.4%), and on both 6 and 12 leads (96.8%; p
ISSN:0002-9149
1879-1913
DOI:10.1016/S0002-9149(97)00202-6