Body surface potential mapping improves diagnosis of acute myocardial infarction in those with significant left main coronary artery stenosis

Significant stenosis of the left main coronary artery is encountered at angiography in approximately 0.5% of patients with acute myocardial infarction. Non-invasive diagnosis of left main coronary artery stenosis is challenging. It may result in ST-segment abnormalities on initial 12-lead electrocardiogram, e.g. ST-elevation in lead aVR, anterolateral ST depression and/or T-wave inversion. Acute myocardial infarction as a consequence of left main coronary artery obstruction has a poor prognosis and thus early diagnosis is essential to expedite prompt revascularisation. In this study, we have shown that in patients with acute chest pain and significant left main coronary artery stenosis, ST-segment elevation detected on Body Surface Potential Mapping has an improved sensitivity (93%) over standard ECG in the diagnosis of acute myocardial infarction.