Optimal measuring point for ST deviation in chest pain patients with possible acute coronary syndrome

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Optimal measuring point for ST deviation in chest pain patients with possible acute coronary syndrome. / Lindow, Thomas; Wiiala, Jonathan; Lundager Forberg, Jakob; Touborg Lassen, Annmarie; Brabrand, Mikkel; Platonov, Pyotr; Ekelund, Ulf.

In: Journal of Electrocardiology, Vol. 58, 2020, p. 165-170.

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Lindow, Thomas ; Wiiala, Jonathan ; Lundager Forberg, Jakob ; Touborg Lassen, Annmarie ; Brabrand, Mikkel ; Platonov, Pyotr ; Ekelund, Ulf. / Optimal measuring point for ST deviation in chest pain patients with possible acute coronary syndrome. In: Journal of Electrocardiology. 2020 ; Vol. 58. pp. 165-170.

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TY - JOUR

T1 - Optimal measuring point for ST deviation in chest pain patients with possible acute coronary syndrome

AU - Lindow, Thomas

AU - Wiiala, Jonathan

AU - Lundager Forberg, Jakob

AU - Touborg Lassen, Annmarie

AU - Brabrand, Mikkel

AU - Platonov, Pyotr

AU - Ekelund, Ulf

N1 - Copyright © 2019 Elsevier Inc. All rights reserved.

PY - 2020

Y1 - 2020

N2 - 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.

AB - 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.

U2 - 10.1016/j.jelectrocard.2019.12.012

DO - 10.1016/j.jelectrocard.2019.12.012

M3 - Article

VL - 58

SP - 165

EP - 170

JO - Journal of Electrocardiology

JF - Journal of Electrocardiology

SN - 1532-8430

ER -