Abstract 212: Synthesized 18-Lead Electrocardiogram in Patients Treated in the Emergency Department
Background: Standard 12-lead electrocardiogram (ECG) speed the diagnosis and shorten the time to reperfusion for acute coronary syndrome (ACS). However, there is insufficient information of posterior (V7-V9) and/or right (V3R-V5R) ventricular area in which data are not routinely recorded. Recently, a non-invasive standard 12-lead ECG system with an additional 6 leads (Synthesized 18-Lead ECG; Nihonkoden Co. Ltd.) has been developed.
Methods: We conducted a prospective, blind, observational study of patients who treated in the emergency department (ED) of our hospital. From symptoms and signs on arrival at the ED, physicians judged whether ECG was necessary for diagnosis and primary care. We entrusted the medical examination and primary care to the physicians. When physicians suspected a patient with emergency cardiovascular disease, a synthesized 18-lead ECG was recorded within 10 minutes of ED arrival. The primary endpoint was a diagnosis of acute ST-elevation myocardial infarction (STEMI).
Results: Of the 7,638 patients treated in the ED, 6,041 were adults. Of the 6,041 adults, 1,546 (26%) underwent synthesized 18-Lead ECG within 10 minutes of ED arrival. Of the 1,546 patients undergoing synthesized 18-Lead ECG, 407 (26%) were judged as possible cases of emergency cardiovascular disease with chest discomfort in 31%, disturbance of consciousness in 21% and dyspnea in 16% etc. Of these 407 patients with possible emergency cardiovascular disease, 25 (6%) were diagnosed as ACS, including 13 STEMI, 5 Non-STEMI and 7 unstable angina. Of the 13 STEMI patients, 2 (15%) were diagnosed as STEMI complicated by right ventricular infarction, including one moderate right ventricular dysfunction and one syncope.
Conclusion: Synthesized 18-Lead ECG with right-sided and posterior precordial leads (V3R-V5R and V7-V9), was useful in the rapid diagnosis of STEMI within 10 minutes of ED arrival, especially in the early detection of right ventricular infarction.
- Acute coronary syndromes
- Myocardial infarction, STEMI
- Myocardial infarction, NSTEMI
- © 2013 by American Heart Association, Inc.