Validation of new enhanced ACC/ESC STEMI criteria on the population of patients with suspected myocardial infarction

Current electrocardiographic criteria for identifying patients with ST-segment elevation myocardial infarction (STEMI) perform with high specificity (SP), but low sensitivity (SE). Based on data acquired during balloon-inflation angioplasty, we found that the SE of ACC/ESC STEMI criteria can be improved without any loss of SP by considering ST elevation in 3 added pairs of contiguous leads (aVL, -III; III, -aVL; and -V2, -V3). The aim of the present study was to validate these findings on an independent dataset consisting of 12-lead ECGs of patients with (n = 58) and without (n = 58) acute myocardial infarction. ST deviation was measured at J point in 12 standard leads by a cardiologist from paper tracings, with resolution of 50?V; these tracings were then scanned and high-resolution ST measurements were made from computer monitor. By using manual measurements from paper, the detection of ischemic state using the existing STEMI criteria achieved SE/SP of 50/97%, whereas with enhanced STEMI criteria SE/SP were 66/97%. Computer-assisted measurements yielded SE/SP of 43/98% for the existing and 55/98% for enhanced STEMI criteria; however, at thresholds for ST elevation lowered by 30 ?V (i.e., by emulating ?rounding? in readings from paper) SE/SP values for computer-assisted measurements equaled those for manual ones. Thus this study confirmed that existing ACC/ESC STEMI criteria enhanced by 3 additional features yield improved SE of ischemia detection without lowering SP.