Enhancing Ischemia Detection: A Comparative Analysis of 15-Lead vs. 12-Lead ECG in Differential Diagnosis and Prognostic Prediction

Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide, making rapid and accurate diagnosis an urgent priority in cardiology. The electrocardiogram (ECG) is the frontline tool in diagnosing acute coronary syndromes (ACS), yet the widely used 12-lead ECG falls short in detecting infarctions in critical myocardial territories—particularly the right ventricle (RV) and the posterior wall. These regions, often overlooked due to traditional lead placement, can harbor life-threatening ischemia that remains hidden from standard ECG interpretations. The consequences of these diagnostic blind spots are severe. Right ventricular myocardial infarction (RVMI), which frequently accompanies inferior MI, is a major contributor to cardiogenic shock and increased mortality. However, without dedicated right-sided leads, its detection is often missed, leading to inadequate treatment and poor clinical outcomes. Likewise, posterior myocardial infarction (PMI) frequently presents with misleading reciprocal ST-segment depressions in anterior leads rather than clear ST elevations. This diagnostic ambiguity can result in delayed or incorrect management, further compromising patient survival.