Validation of the vessel-specific leads (VSLs) for acute ischemia detection on a dataset with non-ischemic ST-segment deviation

Existing criteria recommended by ACC/ESC for identifying patients with ST-elevation myocardial infarction (STEMI) from the 12-lead ECG perform with high specificity (SP), but low sensitivity (SE). In our previous study, we found that the SE of acute ischemia detection can be markedly improved without any loss of SP by calculating, from the 12-lead ECG, ST elevation in 3 vessel-specific leads (VSLs). To further validate the method, we evaluated the SP using a dataset with non-ischemic ST-segment changes, consisting of 12-lead ECGs of 100 patients. These ECGs were chosen to represent five causes of pathological ST deviation, other than acute coronary occlusion: ventricular pre-excitation, acute pericarditis, early-repolarization syndrome, left ventricular hypertrophy, and left bundle branch block. Both STEMI and VSL criteria were tested by calculating SP as the performance measure. We found that SP of the STEMI criteria was 100%, 4%, 29%, 100%, and 64%, respectively, for the five subgroups. The corresponding values of SP for the VSLs were 92%, 88%, 100%, 77%, and 68%. For the entire group, SP was 57% for the STEMI criteria and significantly higher for the VSLs at 83%. Thus, the VSLs not only are more sensitive in detecting acute ischemia, but also significantly more specific in rejecting patients with non-ischemic ST deviation than the existing STEMI criteria.