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Diagnostic performance of standard electrocardiogram for prediction of infarct related artery and site of coronary occlusion in unselected STEMI patients undergoing primary percutaneous coronary intervention
- Publication Year :
- 2014
-
Abstract
- AIMS: To evaluate the relationship between ECG patterns and infarct related artery (IRA) in an all-comer population with ST-segment elevation myocardial infarction (STEMI) and validate current criteria for identifying IRA (right coronary artery (RCA) versus left circumflex artery (LCA)) in inferior STEMI and for diagnosing left main (LM) or left anterior descendent artery occlusion (LAD) in anterior STEMI.METHODS AND RESULTS: We retrospectively analysed ECGs at presentation and coronary angiogram in 885 consecutive patients undergoing primary percutaneous coronary intervention. Six ECG patterns were identified: anterior-STEMI (n=433; 49.0%), inferior-STEMI (i=365; 43.0%), lateral-STEMI (n=43; 5.0%), left bundle branch block (n=26; 3.0%), posterior-STEMI (n=7; 1.0%) and de Winter sign (n=7; 1.0%). The last two ECG patterns were univocally associated with LCA and proximal LAD occlusion respectively. In patients with inferior STEMI, predefined ECG algorithms showed high sensitivity(>90%) for RCA occlusion and high specificity(>90%) for LCA. The diagnostic performance was mainly determined by RCA dominance. In anterior STEMI the vectorial analysis of ST deviation in both frontal and horizontal planes could identify patients with LM/proximal LAD occlusion (adjusted-odds ratio for in-hospital mortality =2.45, 95% confidence interval: 1.31-4.56, p = 0.005) with low sensitivity (maximum 60%; using ST-depression in lead II, III, aVF + ΣSTE aVR + V1-ST depression V6≥0) and high specificity (maximum 95%; using ST-depression in inferior leads + ST-depression in V6).CONCLUSION: In STEMI undergoing primary percutaneous coronary intervention, six ECG patterns can be identified with a non-univocal relationship to the IRA. In inferior STEMI, vectorial analysis of ST deviation identifies IRA with a high appropriateness only when RCA is the dominant artery. In anterior STEMI, criteria derived from both frontal and horizontal planes identify LM/proximal LAD occlusion with high specificity but low sensitivity.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Population
Myocardial Infarction
Infarction
Predictive Value of Test
ST-segment elevation
Critical Care and Intensive Care Medicine
Coronary Angiography
NO
Electrocardiography
Percutaneous Coronary Intervention
Predictive Value of Tests
Retrospective Studie
Internal medicine
medicine
Humans
Infarct related artery
Myocardial infarction
cardiovascular diseases
education
Coronary Vessel
Retrospective Studies
Aged
education.field_of_study
business.industry
Medicine (all)
Standard electrocardiogram
Percutaneous coronary intervention
General Medicine
site of coronary occlusion
Middle Aged
medicine.disease
Coronary Vessels
Electrocardiogram
infarct related artery
Coronary Occlusion
Female
Treatment Outcome
surgical procedures, operative
Coronary occlusion
cardiovascular system
Cardiology
Radiology
Cardiology and Cardiovascular Medicine
business
Human
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....20b2d9e065c76ecec499c7fbf621241c