Usefulness of synthesized 18-lead electrocardiography in the diagnosis of ST-elevation myocardial infarction: A pilot study

OBJECTIVE: This was a pilot retrospective case-series study performed to investigate whether synthesized 18-lead electrocardiogram (ECG) could improve the accuracy of infarction site diagnosis in patients presenting with ST-elevation myocardial infarction (STEMI).

METHOD: Of 103 consecutive patients with acute coronary syndrome who underwent emergency coronary angiography between October 1, 2014 and December 10, 2015, 33 patients fulfilling the diagnostic criteria for STEMI were enrolled in this study.

RESULTS: Comparison by the infarct-related coronary artery revealed that ST elevation in the 6 synthesized leads (any of syn-V3R -V5R and syn-V7 -V9 leads), in addition to ST elevation in the standard 12-lead ECG, was lower in patients in whom the left anterior descending coronary artery (LAD) was the infarct-related coronary artery LAD vs. right coronary artery (RCA) vs. left circumflex coronary artery (LCX): 3/11 [27.3%] vs. 4/6 [66.7%] vs. 11/16 [68.6%], p=0.007). The above data indicate that the synthesized 18-lead ECG was useful for diagnosing STEMI in 18 of the 33 patients (54.5%). Furthermore, in 17 of the 18 patients (94.4%), the area of myocardium supplied by the infarct-related coronary artery was consistent with the site of infarction estimated from the ST elevation profile in the 6 synthesized leads.

CONCLUSION: The diagnosis of STEMI by synthesized 18-lead ECG is useful to identify the site of infarction in patients with infarction of the right ventricular wall (supplied by the RCA) or posterior wall of the left ventricle (supplied by the LCX), which often fail to be diagnosed by the standard 12-lead ECG.