Analysis of BSPM identifies areas on the torso where the most significant ST changes most frequently occur in acute MI. Two leads from areas with the most abnormal ST changes achieve optimal classification in each MI class. Of these six leads, five are outside the standard precordial lead positions. ST depression is the most potent discriminator for each MI group and contains information independent from ST elevation. Quantitative analysis of ST magnitude at each electrode site allows determination of best thresholds for ECG criteria. Appropriate selection of ECG leads may help remove inconsistencies in current ECG selection criteria and improve comparability of treatment results.
Diagnosis of acute NQMI and QMI (also in the presence of LVH) can be improved substantially by appropriate selection of ECG leads and features. Comparison of discriminant maps from groups A, B, and C does not support the concept of acute NQMI as a distinct ECG entity but rather as a group with infarcts of smaller size. However, pathophysiological and clinical differences between acute NQMI and acute QMI influence long-term risks and may define different therapeutic approaches.
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