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

Background Delayed medical attendance is a leading cause of death in patients with ST elevation myocardial infarction (STEMI). Methods We 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 (STDV_N). The study included 60 patients undergoing coronary artery occlusion (CAO) during balloon inflation and 30 healthy subjects. Results STDV_N 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). Conclusions The 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.