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Acute detection of ST-elevation myocardial infarction missed on standard 12-Lead ECG with a novel 80-lead real-time digital body surface map: primary results from the multicenter OCCULT MI trial.

Publication ,  Journal Article
Hoekstra, JW; O'Neill, BJ; Pride, YB; Lefebvre, C; Diercks, DB; Peacock, WF; Fermann, GJ; Gibson, CM; Pinto, D; Giglio, J; Chandra, A ...
Published in: Ann Emerg Med
December 2009

STUDY OBJECTIVE: Although 80-lead ECG body surface mapping is more sensitive for ST-elevation myocardial infarction (STEMI) than the 12-lead ECG, its clinical utility in chest pain in the emergency department (ED) has not been studied. We sought to determine the prevalence, clinical care patterns, and clinical outcomes of patients with STEMI identified on 80-lead but not on 12-lead (80-lead-only STEMI). METHODS: The Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction trial was a multicenter prospective observational study of moderate- to high-risk chest pain patients presenting to the ED. Patients received simultaneous 12-lead and 80-lead ECGs as part of their initial evaluation and were treated according to the standard of care, with clinicians blinded to the 80-lead results. The primary outcome of the trial was door-to-sheath time in patients with 80-lead-only STEMI versus patients with STEMI identified by 12-lead alone (12-lead STEMI). Secondary outcomes included angiographic and clinical outcomes at 30 days. RESULTS: One thousand eight hundred thirty patients were evaluated, 91 had a discharge diagnosis of 12-lead STEMI, and 25 patients met criteria for 80-lead-only STEMI. Eighty-four of the 91 12-lead STEMI patients underwent cardiac catheterization, with a median door-to-sheath time of 54 minutes, versus 14 of the 25 80-lead-only STEMI patients, with a door-to-sheath time of 1,002 minutes (estimated treatment difference in median=881; 95% confidence interval 181 to 1,079 minutes). Clinical outcomes and revascularization rates, however, were similar between 80-lead-only STEMI and 12-lead STEMI patients. CONCLUSION: The 80-lead ECG provides an incremental 27.5% increase in STEMI detection versus the 12-lead. Patients with 80-lead-only STEMI have adverse outcomes similar to those of 12-lead STEMI patients but are treated with delayed or conservative invasive strategies.

Duke Scholars

Published In

Ann Emerg Med

DOI

EISSN

1097-6760

Publication Date

December 2009

Volume

54

Issue

6

Start / End Page

779 / 788.e1

Location

United States

Related Subject Headings

  • Survival Analysis
  • Sensitivity and Specificity
  • Prospective Studies
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female
  • Emergency & Critical Care Medicine
  • Electrocardiography
 

Citation

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Hoekstra, J. W., O’Neill, B. J., Pride, Y. B., Lefebvre, C., Diercks, D. B., Peacock, W. F., … Krucoff, M. (2009). Acute detection of ST-elevation myocardial infarction missed on standard 12-Lead ECG with a novel 80-lead real-time digital body surface map: primary results from the multicenter OCCULT MI trial. Ann Emerg Med, 54(6), 779-788.e1. https://doi.org/10.1016/j.annemergmed.2009.06.525
Hoekstra, James W., Brian J. O’Neill, Yuri B. Pride, Cedric Lefebvre, Deborah B. Diercks, W Frank Peacock, Gregory J. Fermann, et al. “Acute detection of ST-elevation myocardial infarction missed on standard 12-Lead ECG with a novel 80-lead real-time digital body surface map: primary results from the multicenter OCCULT MI trial.Ann Emerg Med 54, no. 6 (December 2009): 779-788.e1. https://doi.org/10.1016/j.annemergmed.2009.06.525.
Hoekstra, James W., et al. “Acute detection of ST-elevation myocardial infarction missed on standard 12-Lead ECG with a novel 80-lead real-time digital body surface map: primary results from the multicenter OCCULT MI trial.Ann Emerg Med, vol. 54, no. 6, Dec. 2009, pp. 779-788.e1. Pubmed, doi:10.1016/j.annemergmed.2009.06.525.
Hoekstra JW, O’Neill BJ, Pride YB, Lefebvre C, Diercks DB, Peacock WF, Fermann GJ, Gibson CM, Pinto D, Giglio J, Chandra A, Cairns CB, Konstam MA, Massaro J, Krucoff M. Acute detection of ST-elevation myocardial infarction missed on standard 12-Lead ECG with a novel 80-lead real-time digital body surface map: primary results from the multicenter OCCULT MI trial. Ann Emerg Med. 2009 Dec;54(6):779-788.e1.
Journal cover image

Published In

Ann Emerg Med

DOI

EISSN

1097-6760

Publication Date

December 2009

Volume

54

Issue

6

Start / End Page

779 / 788.e1

Location

United States

Related Subject Headings

  • Survival Analysis
  • Sensitivity and Specificity
  • Prospective Studies
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female
  • Emergency & Critical Care Medicine
  • Electrocardiography