Datum: 20. Juli 2013 Kategorie:

Cardiogoniometry as a diagnostic tool in patients with acute coronary syndromes

Background:  Cardiogoniometry (CGM) is a novel electrocardiac method utilising computer-assisted threedimensional information on cardiac potentials.

Objective:  To investigate the potential of CGM in discriminating non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and relevant coronary stenosis upon hospital admission by prospectively comparing its sensitivity, specificity and accuracy against those of a single troponin test and a 12-lead ECG performed on admission

Design:   A multicenter prospective observational trial.

Setting:   Eight interventional cardiac centres in Germany.

Patients:  A cohort of 216 patients (mean age 67 years, 34.7 % female) who presented with acute chest pain or dyspnoea without ST-segment elevation and were scheduled for coronary angiography within 72 h of admission.

Intervention: Pre-angiography screening by CGM, troponin test, 12-lead ECG

Main outcome:  Measures ECG, troponin and CGM on admission compared with final diagnosis of NSTE-ACS or relevant diameter stenosis C70 % verified by an independent review board and an angiographic core laboratory.

Results:  NSTE-ACS was finally confirmed in 162 cases, whereas the remaining 54 cases without proof of NSTEACS served as controls. Diagnostic sensitivity for NSTEACS was 28, 50 and 69 % and specificity 78, 96 and 54 % for first ECG, serial troponin and first CGM, respectively. Accuracy was 40, 62 and 65 %. The sensitivity of the tests to detect relevant coronary stenosis (n = 126) was 32, 53 and 74 %, respectively. The sensitivity of CGM to detect NSTE-ACS (65 %) or relevant stenosis (71 %) was high even in patients with normal troponin and ECG.

Conclusions:  CGM can detect NSTE-ACS at first medical contact. CGM in conjunction with traditional markers, 12-lead ECG and troponin may effectively aid early decision making in patients presenting with acute chest pain.

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