{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T17:30:55Z","timestamp":1793381455054,"version":"4.5.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,3,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Left circumflex culprit is often missed by the standard 12\u2010lead\n              <jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content>\n              . Extended lead systems (body surface potential map [\n              <jats:styled-content style=\"fixed-case\">BSPM<\/jats:styled-content>\n              ]) should improve the diagnosis of culprit left circumflex stenosis with myocardial infarction.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Retrospective analysis of a hospital research registry (August 2000\u2013August 2010) comprising consecutive patients with (1) ischemic\u2010type chest pain at rest; (2) 12\u2010lead\n              <jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content>\n              and 80\u2010lead\n              <jats:styled-content style=\"fixed-case\">BSPM<\/jats:styled-content>\n              at first medical contact; and (3) cardiac troponin\u2010T 12\u00a0hours after symptom onset and\/or creatine kinase MB fraction, were undertaken. Enrolled in the cohort were patients with culprit left circumflex stenosis (thrombolysis in myocardial infarction flow grade 0\/1) at angiography. Acute myocardial infarction\n              <jats:styled-content style=\"fixed-case\">AMI<\/jats:styled-content>\n              was defined as cardiac troponin\u2010T \u22650.1\u00a0\u03bcg\/L and\/or creatine kinase MB fraction &gt;2 upper limits of normal. Enrolled were 482 patients: 168 had exclusion criteria. Of the remaining 314 (age 64\u00b111\u00a0years; 62% male), 254 (81%) had\n              <jats:styled-content style=\"fixed-case\">AMI<\/jats:styled-content>\n              : of these, 231 had\n              <jats:styled-content style=\"fixed-case\">BSPM STE<\/jats:styled-content>\n              \u2014sensitivity 0.91, specificity 0.72, positive predictive value 0.93, negative predictive value 0.65, and c\u2010statistic 0.803 for\n              <jats:styled-content style=\"fixed-case\">AMI<\/jats:styled-content>\n              (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Of those with\n              <jats:styled-content style=\"fixed-case\">BSPM STE<\/jats:styled-content>\n              and\n              <jats:styled-content style=\"fixed-case\">AMI<\/jats:styled-content>\n              (n=231),\n              <jats:styled-content style=\"fixed-case\">STE<\/jats:styled-content>\n              was most frequently detected in the posterior (n=111, 48%), lateral (n=53, 23%), inferior (n=39, 17%), and right ventricular (n=21, 9%) territories.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Among patients with 12\u2010lead\n              <jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content>\n              non\u2010ST\u2010segment\u2013elevation myocardial infarction and culprit left circumflex stenosis, initial\n              <jats:styled-content style=\"fixed-case\">BSPM<\/jats:styled-content>\n              identifies ST\u2010segment elevation beyond the territory of the 12\u2010lead\n              <jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content>\n              . Greater use of the\n              <jats:styled-content style=\"fixed-case\">BSPM<\/jats:styled-content>\n              may result in earlier identification of\n              <jats:styled-content style=\"fixed-case\">AMI<\/jats:styled-content>\n              , which may lead to more rapid reperfusion.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.118.011029","type":"journal-article","created":{"date-parts":[[2019,3,5]],"date-time":"2019-03-05T10:00:46Z","timestamp":1551780046000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Improving the Diagnosis of Culprit Left Circumflex Occlusion With Acute Myocardial Infarction in Patients With a Nondiagnostic 12\u2010Lead ECG at Presentation: A Retrospective Cohort Study"],"prefix":"10.1161","volume":"8","author":[{"given":"Michael J.","family":"Daly","sequence":"first","affiliation":[{"name":"Heart Centre Royal Victoria Hospital Belfast United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Scott","sequence":"additional","affiliation":[{"name":"Heart Centre Royal Victoria Hospital Belfast United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark T.","family":"Harbinson","sequence":"additional","affiliation":[{"name":"Centre for Vision and Vascular Sciences Queen's University Belfast United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Adgey","sequence":"additional","affiliation":[{"name":"Heart Centre Royal Victoria Hospital Belfast United 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