Classification of ST-elevation acute myocardial infarction, acute pericarditis, and benign early repolarization

Autor: James E. Lindauer, Galen S. Wagner, Ronald H. Selvester, Sophia Zhou, James Clifton, Eric D. Helfenbein
Rok vydání: 2000
Předmět:
Zdroj: Journal of Electrocardiology. 33:251
ISSN: 0022-0736
DOI: 10.1054/jelc.2000.21675
Popis: Reperfusion therapy improves survival of patients with ST elevation early acute myocardial infarction (STEAMI). In prehospital electrocardiography (ECG), a key component of clinical decision support for patients with symptoms suggesting acute coronary syndromes would be an automated quick and accurate diagnosis of STEAMI. Since such a computerized algorithm must consider ST segment elevation criteria, its development is challenged by cardiac conditions other than STEAMI. Confounders, such as acute pericarditis and benign early repolarization, degrade the performance of such algorithms. This study analyzed ST elevation characteristics in three diagnostic categories: STEAMI, acute pericarditis, and benign early repolarization. A statistical tree classification method was used to obtain a satisfactory classification among STEAMI and the other two groups. Twelve-lead resting EGGs were selected from the Providence Medical Center ECG database. Serial ECG characteristics were used to define the patient groups: STEAMI (321 pts)-resolution nor Q wave evolution. ECGs at 500 samples/sec were analyzed using Agilent Technologies' 12-lead resting ECG analysis program. Sensitivity and specificity of the computerized ECG analysis algorithm are: n Sensitivity Specificity STEAMI 321 87% 99% Acute Pericarditis 115 75% 95% Benign Early Repolarization 153 76% 98% When benign early repolarization and acute pericarditis are grouped together as a Non-STEAMI group, the sensitivity and specificity are: n Sensitivity Specificity STEAMI 321 87% 99% Non-STEAMI 268 86% 99% Benign early repolarization and acute pericarditis tend to mimic the ECG diagnosis of STEAMI. However, in STEAMI the ST elevation is localized to a portion of the ECG leads and is often accompanied by ST depression in other leads; in acute pericarditis there is diffuse ST elevation with minimal difference between the maximal and minimal amphitudes; in benign early repolarization ST elevation is also diffuse but higher in amplitudes than acute pericarditis group in all leads except VI and III. Tall T amplitude in all leads but VI and III is another significant feature to distinguish benign early repolarization from acute pericarditis and early acute MI. This new algorithm provides both high sensitivity and specificity for STEAMI diagnosis. Visibly depressed PR segment and the shape of ST elevation were not used but could potentially further improve the distinction between acute pericarditis and benign early repolarization.
Databáze: OpenAIRE
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