High-Resolution Holter 12-lead ECG from Chest Pain Patients

IDENTIFICATION : E-HOL-12-0171-014

Study Design: Tthe Ischemia Monitoring and Mapping in the Emergency Department in Appropriate Triage and Evaluation of Acute Ischemic Myocardium (IMMEDIATE AIM) study is a prospective trial. Patients were enrolled in the study between 2002 and 2004 and 1-year follow-up was completed in December 2005. The overall goal of the IMMEDIATE AIM study was to improve the noninvasive electrocardiogram (ECG) diagnosis of patients who present to the ED with acute coronary syndrome. Specific aims were to (1) acquire continuous, 24-hour, standard 12-lead ECG Holter recordings in cohorts of ED patients undergoing evaluation for possible acute coronary syndrome, (2) simultaneously acquire continuous, 24-hour Holter recordings from electrode sites considered optimal for ischemia detection (Fig. 1) and then estimate body surface potential maps (EBSPM), and (3) compare the sensitivity and specificity of standard electrocardiography with the EBSPM method for identifying acute myocardial ischemia and infarction.

Study Population:

Average of Age Gender    
FinalDx f m Grand Total
Non ACS 67.3 63.0 65.6
Non-cardiac 60.7 60.2 60.5
Non-ST Elev MI 73.3 75.0 73.5
ST-Elev MI   66.5 66.5
Unstb Angina 65.7 63.8 64.5
Grand Total 65.5 63.1 64.4

 

Count of Gender

 

Non-cardiac(1)

    
FinalDx 0 1 Grand Total
Non ACS 82   82
Non-cardiac   46 46
Non-ST Elev MI 9 9
ST-Elev MI 6 6
Unstb Angina 28 28
Grand Total 125 46 171
 

ECG Number of Leads: 12 lead standard configuration

ECG Sampling Frequency : 1000Hz

ECG Amplitude Resolution: 3.75 uV

File Naming Convention: Each filename is composed by a unique "ID".

Clinical Information:

  1. Age (yrs)
  2. Gender (m/f)
  3. Race: (Racial Categories):
    0=Unknown
    1=American Indian or Alaska Native: A person having origins or any of the original
    peoples of North, Central, or South America; and who maintains tribal affiliations or
    community attachment.
    2=Black or African American: Persons having origins in any of the black racial groups of Africa. Terms including Haitian or Negro can be used in addition to Black or African American.
    3=Asian: Persons having origins in the Far East, Southeast Asia, or the Indian subcontinent including Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
    4=White: A person having origins in Europe, the Middle East, or North Africa.
    5=Pacific Islander: Persons having origins in any of the Hawaiian islands, Guam, Samoa, or other Pacific Islands.
  4. Latino: (Ethnic Categories): Mark Yes to this question if the patient is of Latino, Hispanic, or Spanish origin. This is defined as a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
  5. 51. Final Diagnosis: Final diagnosis from this hospitalization taken from the discharge summary
    0=ST Elevation MI (If type of MI is unclear on the discharge summary refer to Kirstens diagnosis of the Initial ECG if marked positive for ST elevation then the MI is coded as a ST Elevation MI if not the MI is coded as a Non-ST Elevation MI)
    1=Non-ST Elevation MI
    2=Unstable Angina (Under the ICD 9 code system Intermediate Coronary Syndrome as Unstable Angina, in addition any clinical course that describes unstable angina should be coded as such
    3=Non-Acute Coronary Syndrome CV Condition (excludes MI or unstable angina); e.g. valvular heart disease, CHF, pericarditis, new onset arrhythmia, stable angina, HTN crisis, aortic dissection or aneurysm, etc. Under the ICD 9 code system Other Chest Pain, Atypical Chest Pain, and Unspecified Chest Pain should be coded as a Non-ACS Syndrome.
    4=Non-Cardiac Condition; e.g. pneumonia, CVA, GIB, DKA, Hyperkalemia, sepsis
  6. CV Medical History: Indicate conditions present in the patients past medical history obtained from the physicians notes
    1. Prior MI
    2. Hx of Angina Pectoris
    3. Prior CABG
    4. Prior PCI (PTCA, Stent): history of any type of transcatheter revascularization procedure done in a cardiac cath setting ( PTCA, stent, laser, direction coronary atherectomy, etc.) prior to this enrollment
  7. Hx CAD: history of coronary artery disease diagnosed by cardiac angiography, prior MI, prior CABG, prior PCI, or history of angina pectoris
  8. Cath Lab: (y/n)
  9. 1st Troponin I Level: Level of the initial Troponin I drawn during this hospitalization
  10. Peak Troponin I Level: Highest Troponin I level during this hospitalization-usually occurring in the first 24-36 hours of hospitalization
  11. Peak CK Level: Highest CK level during this hospitalization
  12. Peak CK-MB: Highest CK-MB level during this hospitalization
  13. Coronary Artery Vessels showing 50% stenosis based on current/or past cardiac catheterizations/interventions
    1. LAD: Left Anterior Descending (includes the main LAD or any of its branches such as the diagonals and ramus intermedius)
    2. RCA: Right Coronary Artery (includes the main RCA or any of its branches such as the right ventricular or acute marginal)
    3. Left Circ: Left Circumflex (includes the main LCS or any of its branches such as the obtuse marginals or posterolateral),
    4. Left Main
  14. Complications during Hospitalization:
    Cardiac Arrest
    Cardiogenic Shock
    Severe Heart Failure/Pulmonary Edema new development after admission
    Extension of MI: only possible for patients that were admitted with AMI diagnosis
    By a re-elevation of cardiac enzymes, CK and CK-MB
  15. Hx of Hypercholesterolemia: 1) documented serum cholesterol 240mg/dl or 2) prior diagnosis by a physician when the patient cannot remember an exact value or the value is not recorded in the patients previous medical record or evident by medication history.
  16. Hx of Hypertension: evidence or knowledge of hypertension prior to this acute event, treated or untreated with medication
  17. Current Smoker: Is the patient a current smoker (mark yes if quit 1 week ago)
  18. Diabetes: evidence or knowledge of diabetes mellitus treated with insulin, oral agents, or diet alone prior to this acute event
  19. Death : Mark if the patient died during this hospitalization due to CV causes, e.g. cardiogenic shock, AMI, CHF, VF arrest, etc.
  20. Death Cause
  21. Follow-up

Related Publications:

(1) Drew BJ, Schindler DM, Zegre JK, Fleischmann KE, Lux RL. Estimated body surface potential maps in emergency department patients with unrecognized transient myocardial ischemia. J Electrocardiol 2007 November;40(6 Suppl):S15-S20.

(2) Shusterman V, Goldberg A, Schindler DM, Fleischmann KE, Lux RL, Drew BJ. Dynamic tracking of ischemia in the surface electrocardiogram. J Electrocardiol 2007 November;40(6 Suppl):S179-S186.