Optimal measuring point for ST deviation in chest pain patients with possible acute coronary syndrome
Lindow, Thomas LU ; Wiiala, Jonathan ; Lundager Forberg, Jakob LU ; Touborg Lassen, Annmarie ; Brabrand, Mikkel ; Platonov, Pyotr LU and Ekelund, Ulf LU
(2020)
In Journal of Electrocardiology
58.
p.165-170
- Abstract
INTRODUCTION: In the ECG, significant ST elevation or depression according to specific amplitude criteria can be indicative of acute coronary syndrome (ACS). Guidelines state that the ST amplitude should be measured at the J point, but data to support that this is the optimal measuring point for ACS detection is lacking. We evaluated the impact of different measuring points for ST deviation on the diagnostic accuracy for ACS in unselected emergency department (ED) chest pain patients.
MATERIAL AND METHODS: We included 14,148 adult patients with acute chest pain and an ECG recorded at a Swedish ED between 2010 and 2014. ST deviation was measured at the J point (STJ) and at 20, 40, 60 and 80 ms after the J point. A discharge... (More)
INTRODUCTION: In the ECG, significant ST elevation or depression according to specific amplitude criteria can be indicative of acute coronary syndrome (ACS). Guidelines state that the ST amplitude should be measured at the J point, but data to support that this is the optimal measuring point for ACS detection is lacking. We evaluated the impact of different measuring points for ST deviation on the diagnostic accuracy for ACS in unselected emergency department (ED) chest pain patients.
MATERIAL AND METHODS: We included 14,148 adult patients with acute chest pain and an ECG recorded at a Swedish ED between 2010 and 2014. ST deviation was measured at the J point (STJ) and at 20, 40, 60 and 80 ms after the J point. A discharge diagnosis of ACS or not at the index visit was noted in all patients.
RESULTS: In total, 1489 (10.5%) patients had ACS. ST amplitude criteria at STJ had a sensitivity of 28% and a specificity of 92% for ACS. With these criteria, the highest positive and negative predictive values for ACS were obtained near the J point, but the optimal point varied with ST deviation, age group and sex. The overall best measuring points were STJ and ST20.
CONCLUSIONS: This study indicates that the diagnostic accuracy of the ECG criteria for ACS is very low in ED chest pain patients, and that the optimal measuring point for the ST amplitude in the detection of ACS differs between ST elevation and depression, and between patient subgroups.
(Less)
- author
- Lindow, Thomas
LU
; Wiiala, Jonathan
; Lundager Forberg, Jakob
LU
; Touborg Lassen, Annmarie
; Brabrand, Mikkel
; Platonov, Pyotr
LU
and Ekelund, Ulf
LU
- organization
- publishing date
- 2020
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of Electrocardiology
- volume
- 58
- pages
- 6 pages
- publisher
- Elsevier
- external identifiers
-
- scopus:85078761579
- pmid:31901697
- ISSN
- 1532-8430
- DOI
- 10.1016/j.jelectrocard.2019.12.012
- project
- AIR Lund - Artificially Intelligent use of Registers
- language
- English
- LU publication?
- yes
- additional info
- Copyright © 2019 Elsevier Inc. All rights reserved.
- id
- 479a5345-fc0f-452c-a08b-74d2704039f2
- date added to LUP
- 2020-01-08 19:32:07
- date last changed
- 2024-04-17 02:12:28
@article{479a5345-fc0f-452c-a08b-74d2704039f2,
abstract = {{<p>INTRODUCTION: In the ECG, significant ST elevation or depression according to specific amplitude criteria can be indicative of acute coronary syndrome (ACS). Guidelines state that the ST amplitude should be measured at the J point, but data to support that this is the optimal measuring point for ACS detection is lacking. We evaluated the impact of different measuring points for ST deviation on the diagnostic accuracy for ACS in unselected emergency department (ED) chest pain patients.</p><p>MATERIAL AND METHODS: We included 14,148 adult patients with acute chest pain and an ECG recorded at a Swedish ED between 2010 and 2014. ST deviation was measured at the J point (STJ) and at 20, 40, 60 and 80 ms after the J point. A discharge diagnosis of ACS or not at the index visit was noted in all patients.</p><p>RESULTS: In total, 1489 (10.5%) patients had ACS. ST amplitude criteria at STJ had a sensitivity of 28% and a specificity of 92% for ACS. With these criteria, the highest positive and negative predictive values for ACS were obtained near the J point, but the optimal point varied with ST deviation, age group and sex. The overall best measuring points were STJ and ST20.</p><p>CONCLUSIONS: This study indicates that the diagnostic accuracy of the ECG criteria for ACS is very low in ED chest pain patients, and that the optimal measuring point for the ST amplitude in the detection of ACS differs between ST elevation and depression, and between patient subgroups.</p>}},
author = {{Lindow, Thomas and Wiiala, Jonathan and Lundager Forberg, Jakob and Touborg Lassen, Annmarie and Brabrand, Mikkel and Platonov, Pyotr and Ekelund, Ulf}},
issn = {{1532-8430}},
language = {{eng}},
pages = {{165--170}},
publisher = {{Elsevier}},
series = {{Journal of Electrocardiology}},
title = {{Optimal measuring point for ST deviation in chest pain patients with possible acute coronary syndrome}},
url = {{http://dx.doi.org/10.1016/j.jelectrocard.2019.12.012}},
doi = {{10.1016/j.jelectrocard.2019.12.012}},
volume = {{58}},
year = {{2020}},
}