{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:42:09Z","timestamp":1785768129967,"version":"3.56.0"},"reference-count":20,"publisher":"Wiley","license":[{"start":{"date-parts":[[2022,8,17]],"date-time":"2022-08-17T00:00:00Z","timestamp":1660694400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiology Research and Practice"],"published-print":{"date-parts":[[2022,8,17]]},"abstract":"<jats:p>Objective. To assess the clinical utility of synthesized V7\u2013V9 ST-segment elevation (sV7-9 STE) in patients with 12-lead-electrocardiogram (ECG)-based non-STE myocardial infarction (NSTEMI) in diagnosing left circumflex artery (LCx) STEMI-equivalent acute coronary syndrome (ACS). Background. The 12-lead-ECG is insufficient for diagnosing patients with ACS, especially those with an LCx culprit. Methods. We retrospectively examined 219 patients with NSTEMI who underwent synthesized 18-lead ECG acquisition on admission and urgent catheterization. Associations between baseline variables, including sV7-9 STE and LCx STEMI-equivalent ACS, were analyzed using logistic regression models and receiver operating characteristics. LCx-culprit ACS was defined as thrombolysis in myocardial infarction (TIMI) 0\u20131 flow. The association between sV7-9 STE and myocardial damage was also assessed. Results. The mean (SD) age of the population was 68.8 (12.0) years, and 81.7% were men. LCx-culprit NSTEMI occurred in 58 (26.5%) patients and 15 (6.8%) were LCx STEMI-equivalent. SV7-9 STE was observed in 16 patients (7.9%). SV7-9 STE was the sole significant predictor of LCx STEMI-equivalent ACS with an odds ratio of 19.0 (95% CI: 5.6\u201363.9, <jats:inline-formula>\n                     <a:math xmlns:a=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\">\n                        <a:mi>p<\/a:mi>\n                        <a:mo>&lt;<\/a:mo>\n                        <a:mn>0.001<\/a:mn>\n                     <\/a:math>\n                  <\/jats:inline-formula>), area under the curve of 0.71 (95% CI: 0.58\u20130.84), sensitivity of 46.7%, and specificity of 95.6%. After adjustment for confounders, sV7-9 STE was significantly associated with a 308% (95% CI: 78\u2013834%) increase in peak high-sensitivity cardiac troponin I (<jats:inline-formula>\n                     <c:math xmlns:c=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\">\n                        <c:mi>p<\/c:mi>\n                        <c:mo>=<\/c:mo>\n                        <c:mn>0.001<\/c:mn>\n                     <\/c:math>\n                  <\/jats:inline-formula>). Conclusions. SV7-9 STE had sole preprocedural diagnostic utility in detecting LCx STEMI-equivalent ACS with greater myocardial damage among patients with 12 ECG-based NSTEMI. The use of synthesized extra leads on admission may help identify patients with NSTEMI requiring primary revascularization.<\/jats:p>","DOI":"10.1155\/2022\/9582174","type":"journal-article","created":{"date-parts":[[2022,8,18]],"date-time":"2022-08-18T05:35:26Z","timestamp":1660800926000},"page":"1-9","source":"Crossref","is-referenced-by-count":6,"title":["Synthesized 18-Lead Electrocardiogram in Diagnosing Posterior Stemi-Equivalent Acute Coronary Syndrome in Patients with NSTEMI"],"prefix":"10.1155","volume":"2022","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5378-4422","authenticated-orcid":true,"given":"Tomoki","family":"Horie","sequence":"first","affiliation":[{"name":"Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rikuta","family":"Hamaya","sequence":"additional","affiliation":[{"name":"Division of Preventive Medicine, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA, USA"},{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoyo","family":"Sugiyama","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidenori","family":"Hirano","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Hoshino","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihisa","family":"Kanaji","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsumin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taishi","family":"Yonetsu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuo","family":"Sasano","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4004-5292","authenticated-orcid":true,"given":"Tsunekazu","family":"Kakuta","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.09.017"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx393"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(88)92594-6"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1016\/s0735-1097(99)00249-1"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1097\/hco.0b013e32835482b7"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2010.10.137"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000617"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1272\/jnms.78.22"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.4103\/0976-9668.198364"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2019.10.044"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euu337"},{"key":"12","doi-asserted-by":"publisher","DOI":"10.1007\/s00380-019-01483-1"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2016.11.052"},{"key":"14","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1808788"},{"key":"15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198510173131611"},{"key":"16","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2012.12.009"},{"key":"17","doi-asserted-by":"publisher","DOI":"10.4244\/eijv10i1a17"},{"issue":"14","key":"18","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1093\/eurheartj\/ehaa575","article-title":"ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation","volume":"42","author":"J. 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