Coronary Artery Occlusion Detection Using 3-Lead ECG System Suitable for Credit Card-Size Personal Device Integration

• Published in: JACC. Advances (Online) Vol. 2; no. 6; p. 100454
• Main Authors: Shvilkin, Alexei, Vukajlović, Dejan, Bojović, Boško P., Hadžievski, Ljupčo R., Vajdic, Branislav, Atanasoski, Vladimir A., Miletić, Marjan N., Zimetbaum, Peter J., Gibson, C. Michael, Vukčević, Vladan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2023; Elsevier
• Subjects: acute coronary syndrome; Cardiovascular; electrocardiography; myocardial ischemia; Original Research; ST-segment elevation myocardial infarction; vectorcardiography; LCX; vectorcardiography; ECG; ER; LAD; electrocardiography; RCA; acute coronary syndrome; PCI; STEMI; myocardial ischemia; ST-segment elevation myocardial infarction; VCG; left anterior descending coronary artery; emergency room; right coronary artery; electrocardiogram; percutaneous coronary intervention; vectorcardgiographic; left circumflex coronary artery
• ISSN: 2772-963X; 2772-963X
• DOI: 10.1016/j.jacadv.2023.100454

Early coronary occlusion detection by portable personal device with limited number of electrocardiographic (ECG) leads might shorten symptom-to-balloon time in acute coronary syndromes. The purpose of this study was to compare the accuracy of coronary occlusion detection using vectorcardgiographic analysis of a near-orthogonal 3-lead ECG configuration suitable for credit card-size personal device integration with automated and human 12 lead ECG interpretation. The 12-lead ECGs with 3 additional leads (“abc”) using 2 arm and 2 left parasternal electrodes were recorded in 66 patients undergoing percutaneous coronary intervention prior to (“baseline”, n = 66), immediately before (“preinflation”, n = 66), and after 90-second balloon coronary occlusion (“inflation”, n = 120). Performance of computer-measured ST-segment shift on vectorcardgiographic loops constructed from “abc” and 12 leads, standard 12-lead ECG, and consensus human interpretation in coronary occlusion detection were compared in “comparative” and “spot” modes (with/without reference to “baseline”) using areas under ROC curves (AUC), reliability, and sensitivity/specificity analysis. Comparative “abc”-derived ST-segment shift was similar to two 12-lead methods (vector/traditional) in detecting balloon coronary occlusion (AUC = 0.95, 0.96, and 0.97, respectively, P = NS). Spot “abc” and 12-lead measurements (AUC = 0.72, 0.77, 0.68, respectively, P = NS) demonstrated poorer performance (P < 0.01 vs comparative measurements). Reliability analysis demonstrated comparative automated measurements in “good” agreement with reference (preinflation/inflation), while comparative human interpretation was in “moderate” range. Spot automated and human reading showed “poor” agreement. Vectorcardiographic ST-segment analysis using baseline comparison of 3-lead ECG system suitable for credit card-size personal device integration is similar to established 12-lead ECG methods in detecting balloon coronary occlusion. [Display omitted]