A comparison of 12-and 15-lead ECGs in ED chest pain patients: Impact on diagnosis, therapy, and disposition

The objective of this study was to investigate the diagnostic and therapeut ic impact of the 15-lead electrocardiogram (15ECG) on the emergency departm ent (ED) management of chest pain (CP) patients. The design was prospective use of 15ECG with real-time physician survey and retrospective comparison to 12-lead ECG (12ECG). The study took place in a University hospital ED. A dult CP patients participated. During the 15ECG period (June 1996 to July 1 996), 595 patients (92% of CP patients) had 15ECG analysis. Diagnoses of ac ute coronary ischemic syndromes (ACIS) were as follows: 13 acute myocardial infarction (AMI, 7 anterior [ANT], 5 inferior [INF], 1 lateral [LAT], 2 po sterior [POST], 1 right ventricular [RV]) and 136 unstable angina (USA) wit h 47% exhibiting ECG abnormality; the 2 POST and 1 RV AMI occurred in the s etting of coexisting INF AMI. The following management strategies were used : 6 fibrinolytic therapy (TT), 4 primary angioplasty (PTCA), 67 rule-out my ocardial infarction (ROMI), and 144 admission to critical care unit (CCU). During the 12ECG period (June 1995 to July 1995), 599 patients were encount ered. The diagnoses of ACIS were as follows: 11 AMI (5 ANT, 4 INF, 2 LAT) a nd 146 USA with 51% exhibiting ECG abnormality (P = NS for diagnostic compa risons to 15ECG). The following management strategies were used: 5 TT,5 PTC A, 59 ROMI, and 137 admission to CCU (P = NS for all treatment comparisons to 15ECG). Of 15ECG cases 81% had completed real time physician survey, sho wing that the diagnosis and management ACIS were not altered by the 15ECG; physicians felt, however, that the 15ECG provided a more complete anatomic picture of the ACIS. No false-positive cases of additional lead STE were no ted in this investigation except in cases involving abnormal intraventricul ar conduction such as the bundle branch block scenario. The 15ECG provided a more complete description of myocardial injury without altering the ED di agnosis, ED-based therapy, or hospital disposition in adult CP patients. Fu rther study is required to identify patient subset(s) which may benefit fro m the 15ECG. (Am J Emerg Med 2966;18:239-243 Copyright (C) 2000 by W.B, Sau nders Company).