Position of ST-deviation measurements relative to the J-point: Impact for ischemia detection
Sumche Man1, C Cato Ter Haar1, Marjolein C de Jongh1
1Cardiology Department, Leiden University Medical Center, Leiden, The Netherlands.
Insights
Optimal detection of ST-elevation myocardial infarction (STEMI) occurs shortly after the J point on an electrocardiogram (ECG). This study found the most accurate STEMI detection algorithm was at 10 ms post-J point.
Area of Science:
- Cardiology
- Medical Diagnostics
- Electrocardiography
Background:
- No consensus exists on the optimal timing for ST deviation measurement on ECGs for acute ischemia detection.
- Accurate detection of acute myocardial infarction is critical for timely intervention.
Purpose of the Study:
- To determine the optimal time instant relative to the J point for ST deviation measurement in ECGs for acute ischemia detection.
- To evaluate the diagnostic accuracy of different STEMI detection algorithms.
Main Methods:
- Analysis of 53 ECGs from acute coronary syndrome patients and 88 control ECGs.
- ECG amplitude measurements taken every 10 ms from 20 ms before to 80 ms after the J point.
- Comparison of traditional, STEMI equivalent, and a liberal STEMI-detection algorithm.
Main Results:
- The most liberal STEMI-detection algorithm achieved the highest diagnostic accuracy (93.6%) at 10 ms after the J point.
- This algorithm demonstrated high sensitivity (94.3%) and specificity (93.2%).
Conclusions:
- STEMI detection is most accurate when performed close to the J point on the ECG.
- The findings suggest that a liberal algorithm considering both ST elevations and depressions offers superior diagnostic performance.
Background:
There is no consensus about the time instant relative to the J point where ST deviation has to be measured for detection of acute ischemia in the ECG.
Methods:
We analyzed 53 ECGs, recorded preceding emergency catheterization of acute coronary syndrome patients with a completely occluded culprit artery (cases), and 88 control ECGs recorded in the cardiology outpatient clinic. ECG-amplitude measurements were made every 10 ms, between 20 ms before till 80 ms after the J point. STEMI-detection algorithms varied from the traditional STEMI criterion (elevations in at least two adjacent ECG leads), via the STEMI equivalent criterion (depressions in V2 and V3), to the most liberal STEMI-detection algorithm in which elevations as well as depressions in two adjacent leads were considered as signs of ischemia.
Results:
Diagnostic accuracy was highest (93.6%) for the most liberal STEMI-detection algorithm at 10 ms after the J point; sensitivity was 94.3% and specificity was 93.2%.
Conclusion:
The results of our study suggest that STEMI detection close to the J point is optimal.
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