Detection of acute myocardial ischemia by vessel-specific leads derived from the 12-lead electrocardiogram

Our aim was to enhance diagnostic performance of ACC/ESC STEMI criteria based on 12-lead ECG by using criteria from 3 derived vessel-specific leads (VSLs). Study data consisted of 12-lead ECGs acquired during angioplasty-induced ischemic episodes due to balloon inflation in, respectively, LAD (n = 35), RCA (n = 47), and LCx (n = 17) coronary arteries. Three VSLs were derived from 12-lead ECG by previously developed lead transformations. We found that the detection of ischemic state, in any vessel, by means of the ACC/ESC criteria achieved the SE/SP of 60/96% in the total population, whereas in subgroups sorted by vessel SE/SP were 74/97% for LAD, 60/94% for RCA, and 36/100% for LCx. With derived VSLs at 110 muV threshold we achieved in total population SE/SP 84/93% and in subgroups 97/92% for LAD, 77/92% for RCA and 77/100% for LCx. Thus it appears that VSLs can markedly improve detection of ischemia, especially that caused by LCx artery occlusion.