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Li Y, Wu L, Zhao R, Gao Y, Bai G, Guo Z, Chen X, Chen Y, Liu T, Li G. New Electrocardiographic Score for Predicting the Site of Coronary Artery Occlusion in Inferior Wall Acute Myocardial Infarction. Int J Gen Med 2024; 17:3211-3220. [PMID: 39070226 PMCID: PMC11278068 DOI: 10.2147/ijgm.s472692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024] Open
Abstract
Background An electrocardiogram (ECG) was used to determine the type of acute myocardial infarction (MI) and locate the culprit vessel. Inferior wall myocardial infarction (IWMI) patients with the right coronary artery (RCA) as the culprit vessel may have a worse clinical prognosis than the left circumflex artery (LCx). We aimed to develop a new, simple, accurate scoring system to localize the RCA. Methods From January 2018 to January 2020, patients were admitted to the Department of Cardiology of TEDA International Cardiovascular Hospital and the Second Hospital of Tianjin Medical University due to IWMI and coronary angiography confirmed that the infarct-related vessel was a single RCA or LCx. ECG of patients before percutaneous coronary intervention (PCI) was collected to quantitatively analyze the characteristics of ST-segment deviation in non-inferior wall leads (N-IWL) and establish the RCA score in N-IWL. Results 149 patients were enrolled, including 83 in the RCA group and 66 in the LCx group. Finally, ST-segment depression (ST↓) lead I, aVR, V1, and V6, and ST↓≥ 1mm in lead V4 were found to be associated with the location of the RCA. The sensitivity, specificity, and area under the curve (AUC) of the N-IWL RCA scoring system were 77.1%, 72.7%, and 0.83, respectively. The diagnostic ability of the scoring system was better than that of other algorithms and scoring systems. Conclusion ECG helps identify the RCA in patients with IWMI before PCI. The N-IWL RCA score may help identify the culprit vessel as the RCA in patients with IWMI.
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Affiliation(s)
- Yuqing Li
- Tianjin Key Laboratory of Logic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China
| | - Lei Wu
- Tianjin Key Laboratory of Logic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China
- TEDA International Cardiovascular Hospital, Electrophysiological Department, Tianjin, 300457, People’s Republic of China
| | - Rui Zhao
- Tianjin Key Laboratory of Logic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China
- TEDA International Cardiovascular Hospital, Electrophysiological Department, Tianjin, 300457, People’s Republic of China
| | - Yi Gao
- Tianjin Key Laboratory of Logic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China
| | - Geng Bai
- Tianjin Key Laboratory of Logic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China
| | - Ziqiang Guo
- Tianjin Key Laboratory of Logic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China
| | - Xiaolin Chen
- Tianjin Key Laboratory of Logic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China
| | - Yuanlu Chen
- TEDA International Cardiovascular Hospital, Electrophysiological Department, Tianjin, 300457, People’s Republic of China
| | - Tong Liu
- Tianjin Key Laboratory of Logic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China
| | - Guangping Li
- Tianjin Key Laboratory of Logic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China
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Farhat-Sabet A, Smith A, Atwood JE, Pickett C. Localising culprit artery in inferior STEMI. Open Heart 2023; 10:openhrt-2022-002093. [PMID: 36707129 PMCID: PMC9884921 DOI: 10.1136/openhrt-2022-002093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/13/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND ST elevation myocardial infarction (STEMI) represents a cardiac emergency. Time to diagnosis, identification of culprit lesion, and intervention are important. Inferior STEMI represents a dilemma for cardiologists. The territory can be supplied by the right coronary artery (RCA) or the left circumflex coronary artery (LCx). Diagnostic algorithms have been proposed to predict the culprit artery. METHODS We performed a single-centre retrospective cohort analysis of all patients admitted to our hospital from 2008 to 2020 with a diagnosis of inferior STEMI. We examined the diagnostic 12 lead ECG for quantification of ST elevation in leads II and III and compared this to culprit lesion found on angiography. RESULTS There were 304 patients identified with STEMI in our database; 105 were found to have an inferior myocardial infarction by ECG criteria. Ninety-nine were included in our study with either RCA or LCx culprit lesions on angiography (82 males, 17 females). The average age of these patients was 64.9 years old. Sensitivity, specificity, positive predictive value and negative predictive value for ST elevation in lead II exceeding lead III predicting LCx culprit lesion was 0.32 (95% CI 0.13 to 0.57), 0.94 (95% CI 0.86 to 0.98), 0.55 (95% CI 0.29 to 0.78), 0.85 (95% CI 0.81 to 0.89), respectively. Sensitivity, specificity, positive predictive value and negative predictive value for ST elevation in lead III exceeding lead II predicting RCA culprit lesion was 0.94 (95% CI 0.86 to 0.98), 0.32 (95% CI 0.13 to 0.57), 0.85 (95% CI 0.81 to 0.89), 0.55 (95% CI 0.29 to 0.78), respectively. CONCLUSIONS In inferior STEMI, comparison of ST elevation in leads II and III can reliably predict culprit lesion artery and guide intervention. SUBJECT INDEXING Culprit artery localisation, inferior stemi, ECG.
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Affiliation(s)
- Ardalon Farhat-Sabet
- Cardiology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Alexandra Smith
- Cardiology Service, Department of Medicine, Brooke Army Medical Center, San Antonio, Texas, USA
| | - John E Atwood
- Cardiology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Christopher Pickett
- Cardiology Service, Department of Medicine, Brooke Army Medical Center, San Antonio, Texas, USA
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Zhou P, Wu Y, Wang M, Zhao Y, Yu Y, Waresi M, Li H, Jin B, Luo X, Li J. Identifying the culprit artery via 12-lead electrocardiogram in inferior wall ST-segment elevation myocardial infarction: A meta-analysis. Ann Noninvasive Electrocardiol 2023; 28:e13016. [PMID: 36317727 PMCID: PMC9833364 DOI: 10.1111/anec.13016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Inferior wall ST-segment elevation myocardial infarction (STEMI) is mostly caused by acute occlusion of right coronary artery (RCA) and left circumflex artery (LCX). Several methods and algorithms using 12-lead ECG were developed to localize the lesion in inferior wall STEMI. However, the diagnostic properties of these methods remain under-recognized. AIMS The aim of this meta-analysis is to compare the diagnostic properties among the methods of identifying culprit artery in inferior wall STEMI using 12-lead ECG. METHODS We performed a meta-analysis to calculate the pooled sensitive, specificity, area under the curve (AUC) and diagnostic odds ratio (DOR) of each method. RESULTS Thirty-three studies with 4414 participants were included in the analysis. Methods using double leads had better diagnostic properties, especially ST-segment elevation (STE) in III > II [with pooled sensitivity 0.89 (0.84-0.93), specificity 0.68 (0.57-0.79), DOR 17 (9-32), AUC 0.88 (0.85-0.91)], ST-segment depression (STD) in aVL > I [with pooled sensitivity 0.82 (0.72-0.90), specificity 0.69 (0.48-0.86), DOR 11 (4-29), AUC 0.85 (0.81-0.88)], and STD V3/STE III ≤1.2 [with pooled sensitivity 0.88 (0.78-0.95), specificity 0.59 (0.42-0.75), DOR 12 (5-27), AUC 0.82 (0.78-0.85)]. Diagnostic algorithms, including Jim score[pooled sensitivity 0.70 (0.55-0.85), specificity 0.88 (0.75-0.96)], Fiol's algorithm [pooled sensitivity 0.54 (0.44-0.62), specificity 0.92 (0.88-0.96)] and Tierala's algorithm [pooled sensitivity 0.60 (0.49-0.71), specificity 0.91 (0.86-0.96)], were not superior to these simple methods. CONCLUSIONS Our meta-analysis indicated that diagnostic methods using double leads had better properties. STE in III > II together with STD in aVL > I may be the most ideal method, for its accuracy and convenience.
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Affiliation(s)
- Peng Zhou
- Department of CardiologyHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Yingying Wu
- Department of CardiologyHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Meng Wang
- Department of Endocrinology and MetabolismHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Yikai Zhao
- Department of CardiologyHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Yangjie Yu
- Department of CardiologyHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Maieryemu Waresi
- Department of CardiologyHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Huiyang Li
- Department of CardiologyHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Bo Jin
- Department of CardiologyHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Xinping Luo
- Department of CardiologyHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Jian Li
- Department of CardiologyHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
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Chia BL, Yip J, Poh KK. Acute inferior myocardial infarction: the dilemma between anatomic-pathological classification and electrocardiographic diagnosis. Singapore Med J 2019; 60:385-386. [PMID: 31482179 DOI: 10.11622/smedj.2019087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Boon Lock Chia
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - James Yip
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - Kian Keong Poh
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
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Liang H, Wu L, Li Y, Zeng Y, Hu Z, Li X, Sun X, Zhang Q, Zhou X. Electrocardiogram criteria of limb leads predicting right coronary artery as culprit artery in inferior wall myocardial infarction: A meta-analysis. Medicine (Baltimore) 2018; 97:e10889. [PMID: 29901579 PMCID: PMC6024025 DOI: 10.1097/md.0000000000010889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Prior studies have proposed several electrocardiogram (ECG) criteria in limb leads for identifying the culprit coronary artery (CCA) in patients with acute inferior wall myocardial infarction (IWMI). The aim of our study was to conduct an evidence-based evaluation and test accuracy comparison of these criteria. METHODS We searched the PubMed, Embase, and Ovid. Eligible studies to assess the diagnostic performance of ECG criteria predicting CCA in IWMI were reviewed for inclusion. A diagnostic meta-analysis of bivariate approach was performed for pooled estimates of sensitivity and specificity, and meta-regression was implemented to investigate sources of heterogeneity. RESULTS Twenty-four studies with 4431 unique participants met the inclusion criteria. The pooled sensitivity and specificity for ST-segment elevation (STE) in III > II, ST-segment depression (STD) in I, STD in aVL, STD in aVL > I, STE in III > II, and STD in aVL > I were 0.91 (0.88-0.94) and 0.69 (0.53-0.81), 0.80 (0.73-0.87) and 0.69 (0.62-0.76), 0.90 (0.81-0.95) and 0.41 (0.22-0.62), 0.84 (0.75-0.91) and 0.72 (0.48-0.88), and 0.79 (0.62-0.90) and 1.00 (0.37-1.00), respectively. Heterogeneity investigation showed that whether multi-vessel diseased patients were excluded, sample size, publication year, etc., could influence the diagnostic performance. CONCLUSION STE in III > II performed better than other criteria for predicting RCA as CCA in IWMI, and STE in III > II and STD in aVL > I were potential and simple algorithms. ECG could be an effective tool to identify the CCA, but future studies are clearly needed to address the potential of diagnostic and prognostic value.
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Affiliation(s)
- Hao Liang
- Institute of TCM Diagnostics
- Hunan Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine
| | - Lan Wu
- Institute of TCM Diagnostics
- Hunan Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine
| | - Yingchen Li
- The Third Xiangya Hospital, Central South University
- The Affiliated Hospital of Hunan Institute of Traditional Chinese Medicine, Hunan Institute of Traditional Chinese Medicine
| | - Yidi Zeng
- Institute of TCM Diagnostics
- Hunan Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine
| | - Zhixi Hu
- Institute of TCM Diagnostics
- Hunan Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine
| | - Xinchun Li
- Institute of TCM Diagnostics
- Hunan Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine
| | - Xiang Sun
- Cardiology Department, Hospital of Changsha, Changsha, Hunan, China
| | - Qiuyan Zhang
- Institute of TCM Diagnostics
- Hunan Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine
| | - Xiaoqing Zhou
- Institute of TCM Diagnostics
- Hunan Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine
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De Gennaro L, Brunetti ND, Ruggiero M, Rutigliano D, Locuratolo N, Di Biase M, Caldarola P. ST-depression in right precordial leads with inferior STEMI and occluded right coronary artery: intertwined anatomy and ischemic areas. Acta Clin Belg 2017; 72:340-342. [PMID: 27774856 DOI: 10.1080/17843286.2016.1246097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Right coronary artery (RCA) occlusion in inferior acute myocardial infarction is usually heralded by ST-elevation both in inferior and in right precordial leads. We report the case of a 68-year-old male, who presented marked ST-elevation in inferior leads, mirrored by ST-depression in anterior-septal and lateral leads. Right precordial lead electrocardiogram unexpectedly showed ST-depression V1R-V5R leads. Coronary angiography showed mid-left anterior descending (LAD) coronary near-complete occlusion with distal wrapping LAD. Left circumflex artery was not occluded, while RCA was occluded mid tract. The patient was treated with coronary angioplasty on RCA and LAD. Absence of ST-elevation in right precordial leads may be presumably explained by the presence of a large ischemic area distal to mid-LAD near-occlusive stenosis and of a long-wrapping LAD. Complex coronary anatomy and intertwined ischemic areas may underlie apparently discording electrocardiograms.
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Huang X, Ramdhany SK, Zhang Y, Yuan Z, Mintz GS, Guo N. New ST-segment algorithms to determine culprit artery location in acute inferior myocardial infarction. Am J Emerg Med 2016; 34:1772-8. [DOI: 10.1016/j.ajem.2016.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/29/2016] [Accepted: 06/01/2016] [Indexed: 11/28/2022] Open
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Abdelwahed A, Eskola M, Kosonen P, Mäkynen H, Laurikka J, Huhtala H, Inkovaara J, Birnbaum Y, Nikus K. Electrocardiographic findings during balloon angioplasty of the left circumflex coronary artery - influence of location of the ischemic segments with respect to the obtuse margin of the left ventricle. J Electrocardiol 2016; 50:102-110. [PMID: 27378385 DOI: 10.1016/j.jelectrocard.2016.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute left circumflex coronary artery (LCx) occlusion is not easily detected by the standard 12-lead electrocardiogram (ECG). METHODS In 16 patients continuous ECG recording was performed during balloon occlusion. The treated lesions were divided into proximal and distal based on the location of the ischemic segments with respect to the left obtuse margin of the heart. RESULTS Mean ΔST (=ST amplitude during inflation - pre-inflation ST) ≥0.5mm in both leads I and aVL predicted a proximal occlusion site with sensitivity of 62.5% (95% confidence interval [CI] 24.9-91.5%), specificity 100% (95% CI 63.1-100%), positive predictive value 100% (95% CI 47.8-100%), and negative predictive value 72.7% (95% CI 39-94%). In lead III, mean ΔST was +0.3mm in the distal and -0.2mm in the proximal group, respectively (p=0.036). CONCLUSIONS ST elevation in leads I and aVL is associated with myocardial ischemia at or proximal to the left obtuse margin.
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Affiliation(s)
- Ahmed Abdelwahed
- Heart Center, Department of Cardiology, Tampere University Hospital, and School of Medicine, University of Tampere, Finland; Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt
| | - Markku Eskola
- Heart Center, Department of Cardiology, Tampere University Hospital, and School of Medicine, University of Tampere, Finland
| | - Petteri Kosonen
- Heart Center, Department of Cardiology, Tampere University Hospital, and School of Medicine, University of Tampere, Finland; Department of Internal Medicine, Savonlinna Central Hospital, Finland
| | - Heikki Mäkynen
- Heart Center, Department of Cardiology, Tampere University Hospital, and School of Medicine, University of Tampere, Finland
| | - Jari Laurikka
- Heart Center, Department of Cardiothoracic Surgery, Tampere University Hospital, and School of Medicine, University of Tampere, Finland
| | - Heini Huhtala
- School of Health Sciences, University of Tampere, Finland
| | - Jaakko Inkovaara
- Heart Center, Department of Cardiology, Tampere University Hospital, and School of Medicine, University of Tampere, Finland
| | - Yochai Birnbaum
- The Section of Cardiology, the Department Of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Kjell Nikus
- Heart Center, Department of Cardiology, Tampere University Hospital, and School of Medicine, University of Tampere, Finland.
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Mahmoud KS, Abd Al Rahman TM, Taha H, Mostafa S. Significance of ST-segment deviation in lead aVR for prediction of culprit artery and infarct size in acute inferior wall ST-elevation myocardial infarction. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2013.12.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Implications of ST-segment elevation in leads V5 and V6 in patients with reperfused inferior wall acute myocardial infarction. Am J Cardiol 2012; 109:314-9. [PMID: 22078965 DOI: 10.1016/j.amjcard.2011.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 09/13/2011] [Accepted: 09/13/2011] [Indexed: 11/22/2022]
Abstract
During inferior acute myocardial infarction, ST-segment elevation (ST↑) often occurs in leads V(5) to V(6), but its clinical implications remain unclear. We examined the admission electrocardiograms from 357 patients with a first inferior acute myocardial infarction who had Thrombolysis In Myocardial Infarction 3 flow of the right coronary artery or left circumflex artery within 6 hours after symptom onset. The patients were divided according to the presence (n = 76) or absence (n = 281) of ST↑ >2 mm in leads V(5) and V(6). Patients with ST↑ in leads V(5) and V(6) were subdivided into 2 groups according to the degree of ST↑ in leads III and V(6): ST↑ in lead III greater than in V(6) (n = 53) and ST↑ in lead III equal to or less than in V(6) (n = 23). The perfusion territory of the culprit artery was assessed using the angiographic distribution score, and a mega-artery was defined as a score of ≥0.7. ST↑ in leads V(5) and V(6) with ST↑ in lead III greater than in V(6) and ST↑ in leads V(5) and V(6) with ST↑ in lead III equal to or less than in V(6) were associated with mega-artery occlusion and impaired myocardial reperfusion, as defined by myocardial blush grade 0 to 1. Right coronary artery occlusion was most common (96%) in the former, and left circumflex artery occlusion was most common (96%) in the latter, especially proximal left circumflex occlusion (74%). Multivariate analysis showed that ST↑ in leads V(5) and V(6) with ST↑ in lead III greater than that in V(6) (odds ratio 4.81, p <0.001) and ST↑ in leads V(5) and V(6) with ST↑ in lead III equal or less than that in V(6) (odds ratio 5.96, p <0.001) were independent predictors of impaired myocardial reperfusion. In conclusion, ST↑ in leads V(5) and V(6) suggests a greater risk area and impaired myocardial reperfusion in patients with inferior acute myocardial infarction. Furthermore, comparing the degree of ST↑ in lead V(6) with that in lead III is useful for predicting the culprit artery.
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Zhong-qun Z, Nikus KC. Factors influencing and significance of ST-segment deviation in lead aVR in acute inferior wall ST-elevation myocardial infarction. J Electrocardiol 2010; 43:288-93. [DOI: 10.1016/j.jelectrocard.2010.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Indexed: 12/24/2022]
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ST-segment depression in aVR as a predictor of culprit artery and infarct size in acute inferior wall ST-segment elevation myocardial infarction. J Electrocardiol 2009; 43:132-5. [PMID: 19815231 DOI: 10.1016/j.jelectrocard.2009.09.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Indexed: 12/23/2022]
Abstract
BACKGROUND ST-segment depression in lead aVR in acute inferior wall ST-segment elevation myocardial infarction (STEMI) has recently been suggested as a predictor of left circumflex (LCx) artery involvement. The purpose of this study is to evaluate the clinical significance of aVR depression during inferior wall STEMI. METHODS This study included 106 consecutive patients who presented with inferior wall STEMI and underwent urgent coronary angiogram. Clinical and angiographic findings were compared between patients with and without aVR depression > or = 0.1 mV. RESULTS The sensitivity and specificity of aVR depression as a predictor of LCx infarction were 53% and 86%, respectively. In patients with right coronary artery infarction, aVR depression was associated with increased cardiac enzymes and the involvement of a large posterolateral branch, which may explain the larger infarction. CONCLUSIONS ST-segment depression in lead aVR in inferior wall STEMI predicts LCx infarction or larger RCA infarction involving a large posterolateral branch.
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