Best leads in the standard electrocardiogram for the emergency detection of acute coronary syndrome.

BACKGROUND AND PURPOSE The purpose of this study was to determine which leads in the standard 12-lead electrocardiogram (ECG) are the best for detecting acute coronary syndrome (ACS) among chest pain patients in the emergency department. METHODS Neural network classifiers were used to determine the predictive capability of individual leads and combinations of leads from 862 ECGs from chest pain patients in the emergency department at Lund University Hospital. RESULTS The best individual lead was aVL, with an area under the receiver operating characteristic curve of 75.5%. The best 3-lead combination was III, aVL, and V2, with a receiver operating characteristic area of 82.0%, compared with the 12-lead ECG performance of 80.5%. CONCLUSIONS Our results indicate that leads III, aVL, and V2 are sufficient for computerized prediction of ACS. The present results are likely important in situations where the 12-lead ECG is impractical and for the creation of clinical decision support systems for ECG prediction of ACS.