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Detection of acute myocardial ischemia by vessel-specific leads derived from reduced lead sets

The aim of this study was to evaluate whether detection performance of ACC/ESC STEMI criteria based on 12-lead ECG can be improved by using criteria from 3 vessel-specific leads (VSLs) derived from reduced lead sets of 12-lead ECG using 3 limb electrodes at Masson-Likar torso sites and 2 chest electrodes at precordial sites V1 to V6. There are a total of 15 such lead sets and each can be recorded using a 6-wire ECG cable. The VSLs were derived from a large 120-lead mapping database (n=892). Study data consisted of 12-lead ECGs acquired during 99 angioplasty-induced ischemic episodes with prolonged balloon inflation (mean inflation time 4'37") in 35 LAD, 47 RCA, and 17 LCx coronary arteries. The results, which will need validation on larger patient population, suggest that VSLs derived from several reduced lead sets of standard 12-lead ECG can perform better in acute myocardial ischemia identification. For the highest ranked subset (leads II, III, V3, and V6) for all occlusion subgroups the increase in sensitivity was 15.5% for the total population and 17.4%, 6.1%, and 34.7% for LAD, RCA, and LCx subgroups, respectively without any decrease in specificity. Thus it appears that VSLs derived from reduced leads of 12-lead ECG can be used to improve detection of ischemia, especially those caused by the LCx artery occlusion.