ST segment monitoring with a derived 12-lead electrocardiogram is superior to routine cardiac care unit monitoring

Barbara J. Drew, Mary G. Adams, Michele M. Pelter, Shu-Fen Wung

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

BACKGROUND: Prior studies have shown that a derived 12-lead electrocardiogram with a simple electrode configuration is comparable with the standard electrocardiogram for arrhythmia analysis. METHODS: A prospective, comparative, within subjects design was used to compare the value of the derived 12-lead electrocardiogram with that of routine monitoring of leads V1 and II for detection of transient myocardial ischemia in 250 patients treated for unstable angina or myocardial infarction. RESULTS: During 11,532 hours of derived 12-lead ST segment monitoring, 55 (22%) of 250 patients had 176 episodes of ischemia. Of the 55 patients with ischemia, 75% reported no chest pain and 64% had no ischemic ST changes with routine monitoring leads. All five patients who developed angiographically confirmed abrupt reocclusion after percutaneous transluminal coronary angioplasty had ischemic ST changes with the derived electrocardiogram (sensitivity, 100%), compared with only two patients with routine monitoring (sensitivity, 40%). Serious complications occurred in 17% of angina patients with ischemic events compared to 3% of those without ischemia. Length of stay in the cardiac care unit was twice as long in angina patients who had ischemic events. In patients with acute myocardial infarction, ischemic events were not associated with a more complicated hospital course; however, length of stay in the cardiac care unit was longer in patients with recurrent ischemia. CONCLUSIONS: The findings show that derived 12-lead ST monitoring is superior to routine monitoring of leads V1 and II for detecting transient myocardial ischemia. ST monitoring of the derived 12-lead electrocardiogram may identify high-risk patients with unstable angina and provide prognostic information that would not be otherwise available from the usual clinical measures.

Original languageEnglish (US)
Pages (from-to)198-206
Number of pages9
JournalAmerican Journal of Critical Care
Volume5
Issue number3
StatePublished - May 1996
Externally publishedYes

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Electrocardiography
Ischemia
Unstable Angina
Myocardial Ischemia
Length of Stay
Myocardial Infarction
Lead
Coronary Balloon Angioplasty
Chest Pain
Cardiac Arrhythmias
Electrodes

ASJC Scopus subject areas

  • Medicine(all)
  • Nursing(all)

Cite this

ST segment monitoring with a derived 12-lead electrocardiogram is superior to routine cardiac care unit monitoring. / Drew, Barbara J.; Adams, Mary G.; Pelter, Michele M.; Wung, Shu-Fen.

In: American Journal of Critical Care, Vol. 5, No. 3, 05.1996, p. 198-206.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Prior studies have shown that a derived 12-lead electrocardiogram with a simple electrode configuration is comparable with the standard electrocardiogram for arrhythmia analysis. METHODS: A prospective, comparative, within subjects design was used to compare the value of the derived 12-lead electrocardiogram with that of routine monitoring of leads V1 and II for detection of transient myocardial ischemia in 250 patients treated for unstable angina or myocardial infarction. RESULTS: During 11,532 hours of derived 12-lead ST segment monitoring, 55 (22{\%}) of 250 patients had 176 episodes of ischemia. Of the 55 patients with ischemia, 75{\%} reported no chest pain and 64{\%} had no ischemic ST changes with routine monitoring leads. All five patients who developed angiographically confirmed abrupt reocclusion after percutaneous transluminal coronary angioplasty had ischemic ST changes with the derived electrocardiogram (sensitivity, 100{\%}), compared with only two patients with routine monitoring (sensitivity, 40{\%}). Serious complications occurred in 17{\%} of angina patients with ischemic events compared to 3{\%} of those without ischemia. Length of stay in the cardiac care unit was twice as long in angina patients who had ischemic events. In patients with acute myocardial infarction, ischemic events were not associated with a more complicated hospital course; however, length of stay in the cardiac care unit was longer in patients with recurrent ischemia. CONCLUSIONS: The findings show that derived 12-lead ST monitoring is superior to routine monitoring of leads V1 and II for detecting transient myocardial ischemia. ST monitoring of the derived 12-lead electrocardiogram may identify high-risk patients with unstable angina and provide prognostic information that would not be otherwise available from the usual clinical measures.",
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N2 - BACKGROUND: Prior studies have shown that a derived 12-lead electrocardiogram with a simple electrode configuration is comparable with the standard electrocardiogram for arrhythmia analysis. METHODS: A prospective, comparative, within subjects design was used to compare the value of the derived 12-lead electrocardiogram with that of routine monitoring of leads V1 and II for detection of transient myocardial ischemia in 250 patients treated for unstable angina or myocardial infarction. RESULTS: During 11,532 hours of derived 12-lead ST segment monitoring, 55 (22%) of 250 patients had 176 episodes of ischemia. Of the 55 patients with ischemia, 75% reported no chest pain and 64% had no ischemic ST changes with routine monitoring leads. All five patients who developed angiographically confirmed abrupt reocclusion after percutaneous transluminal coronary angioplasty had ischemic ST changes with the derived electrocardiogram (sensitivity, 100%), compared with only two patients with routine monitoring (sensitivity, 40%). Serious complications occurred in 17% of angina patients with ischemic events compared to 3% of those without ischemia. Length of stay in the cardiac care unit was twice as long in angina patients who had ischemic events. In patients with acute myocardial infarction, ischemic events were not associated with a more complicated hospital course; however, length of stay in the cardiac care unit was longer in patients with recurrent ischemia. CONCLUSIONS: The findings show that derived 12-lead ST monitoring is superior to routine monitoring of leads V1 and II for detecting transient myocardial ischemia. ST monitoring of the derived 12-lead electrocardiogram may identify high-risk patients with unstable angina and provide prognostic information that would not be otherwise available from the usual clinical measures.

AB - BACKGROUND: Prior studies have shown that a derived 12-lead electrocardiogram with a simple electrode configuration is comparable with the standard electrocardiogram for arrhythmia analysis. METHODS: A prospective, comparative, within subjects design was used to compare the value of the derived 12-lead electrocardiogram with that of routine monitoring of leads V1 and II for detection of transient myocardial ischemia in 250 patients treated for unstable angina or myocardial infarction. RESULTS: During 11,532 hours of derived 12-lead ST segment monitoring, 55 (22%) of 250 patients had 176 episodes of ischemia. Of the 55 patients with ischemia, 75% reported no chest pain and 64% had no ischemic ST changes with routine monitoring leads. All five patients who developed angiographically confirmed abrupt reocclusion after percutaneous transluminal coronary angioplasty had ischemic ST changes with the derived electrocardiogram (sensitivity, 100%), compared with only two patients with routine monitoring (sensitivity, 40%). Serious complications occurred in 17% of angina patients with ischemic events compared to 3% of those without ischemia. Length of stay in the cardiac care unit was twice as long in angina patients who had ischemic events. In patients with acute myocardial infarction, ischemic events were not associated with a more complicated hospital course; however, length of stay in the cardiac care unit was longer in patients with recurrent ischemia. CONCLUSIONS: The findings show that derived 12-lead ST monitoring is superior to routine monitoring of leads V1 and II for detecting transient myocardial ischemia. ST monitoring of the derived 12-lead electrocardiogram may identify high-risk patients with unstable angina and provide prognostic information that would not be otherwise available from the usual clinical measures.

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