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Published on: May 28, 2019
A tale of two formulas: Differentiation of subtle anterior MI from benign ST segment elevation
Emrah Bozbeyoğlu1, Emre Aslanger2, Özlem Yıldırımtürk1
1Division of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Insights
Two formulas can help differentiate subtle ST-segment elevation (STE) from myocardial infarction (MI) and benign variant (BV) STE. The four-variable formula demonstrated superior sensitivity, specificity, and diagnostic accuracy, making it the preferred choice for clinical use.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Differentiating subtle ST-segment elevation (STE) in anterior myocardial infarction (MI) from benign variant (BV) STE can be challenging.
- Two formulas have been proposed but not externally validated for this diagnostic purpose.
Purpose of the Study:
- To externally validate two proposed formulas for differentiating subtle ST-segment elevation (STE) in anterior myocardial infarction (MI) from benign variant (BV) STE.
- To compare the diagnostic performance of the three-variable and four-variable formulas.
Main Methods:
- Consecutive patients diagnosed with acute anterior ST-elevation myocardial infarction (STEMI) and a control group with noncardiac chest pain were enrolled.
- Electrocardiograms (ECGs) were reviewed for subtle STE, and relevant ECG parameters were measured.
- The sensitivity, specificity, and diagnostic accuracy of the three- and four-variable formulas were calculated.
Main Results:
- The study included 379 anterior MI cases and 200 BV-STE cases, with exclusions based on subtleness criteria and prior interventions.
- The three-variable formula achieved 73.9% sensitivity, 86.7% specificity, and 81.4% accuracy.
- The four-variable formula achieved 83.3% sensitivity, 87.7% specificity, and 85.9% accuracy.
Conclusions:
- Both the three- and four-variable formulas demonstrate reasonable performance in distinguishing subtle STEMI from BV-STE.
- The four-variable formula is recommended for clinical use due to its higher sensitivity, specificity, and diagnostic accuracy.
Background:
It may sometimes be difficult to differentiate subtle ST-segment elevation (STE) due to anterior myocardial infarction (MI) from benign variant (BV) STE. Recently, two related formulas were proposed for this purpose. However, they have never been tested in an external population.
Materials And Methods:
Consecutive patients from May 2017 to January 2018, who were admitted with the diagnosis of acute anterior STEMI, were enrolled. Electrocardiograms were systematically reviewed and only subtle ones were included. First 200 consecutive patients with noncardiac chest pain were also enrolled as a control group. Relevant electrocardiographic parameters were measured.
Results:
A total of 379 anterior MI and 200 BV-STE cases were enrolled during study period. A total of 241 patients in STEMI group were excluded for not matching subtleness criteria, four patients in control group were also excluded because of prior left-anterior descending artery intervention. The three-variable formula, with recommended cut-point of 23.5, had a sensitivity, specificity, and diagnostic accuracy of 73.9%, 86.7%, and 81.4%, respectively. The four-variable formula, with the published cut-point of 18.2, had a sensitivity, specificity, and diagnostic accuracy of 83.3%, 87.7%, and 85.9%, respectively.
Conclusion:
Three- and four-variable formulas with recommended cutoffs have a reasonable sensitivity, specificity, and diagnostic accuracy in differentiating subtle STEMI with BV-STE. Although both perform well, the four-variable formula has a higher sensitivity, specificity, and diagnostic accuracy and should be preferred.
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