Diagnostic accuracy of a novel method for detection of acute transmural myocardial ischemia based upon a self-applicable 3-lead configuration

• We developed and validated a novel method to detect acute coronary artery occlusion.
• Orthonormalized ST difference vector discriminated occlusion from healthy conditions.
• The RELF method outperformed the conventional 12-lead STEMI criteria.
• The RELF method provides a platform for hand-held devices or smart phones.

BackgroundDelayed medical attendance is a leading cause of death in patients with ST elevation myocardial infarction (STEMI).MethodsWe aimed to introduce, develop, and validate a novel method (RELF method) for detection of transmural ischemia based on a new and easy-to-use 3-lead configuration and orthonormalization of ST reference vectors (STDVN). The study included 60 patients undergoing coronary artery occlusion (CAO) during balloon inflation and 30 healthy subjects.ResultsSTDVN was significantly different and an optimal discriminator between CAO patients and healthy subjects (respectively 8.00 ± 4.50 vs. 1.90 ± 0.86 normalized units, p < 0.001). Compared to the 12-lead ECG, the RELF method was sensitive (90 vs. 73%, p = 0.13) and more specific (91 vs. 75%, p < 0.001).ConclusionsThe RELF method is highly accurate for early detection of acute occlusion related ischemia and it outperforms the conventional 12-lead ECG criteria for STEMI. This method provides a platform for self-detection of CAO with handheld devices or smart phones.

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