Abstract
Objectives
In acute inferior ST-segment elevation myocardial infarction (STEMI), multiple criteria
have been proposed to predict the culprit artery based on the 12-lead electrocardiogram
(ECG). We assessed the utilities of 11 traditional and 2 new criteria to devise a
new ECG algorithm to localize the culprit artery in acute inferior STEMI.
Methods
We analyzed electrocardiographic and angiographic findings of 194 consecutive patients
with acute inferior STEMI to devise a new ECG algorithm, further validated in another
cohort of 80 patients with acute inferior STEMI.
Results
In derivation cohort, the 2 new criteria including (1) ST-segment depression in lead
I equal to half of that in lead aVL and (2) equal ST-segment elevation in leads II,
III, and aVF did not prove useful. The most powerful electrocardiographic criteria
were (1) the ratio of ST elevation in lead III to that in lead II, (2) the ratio of
ST depression in lead I to that in lead aVL, and (3) ST changes in lead I; these formed
a 3-step algorithm. Application of this algorithm suggested the location of the culprit
artery in 192 of 194 patients (nearly 99%) in the derivation cohort. In validation
cohort, the algorithm possessed a sensitivity and specificity of 100% and 89%, respectively,
for predicting the right coronary artery and 89% and 100%, respectively, for predicting
the left circumflex artery.
Conclusions
A new 3-step algorithm based on 12-lead ECG is proposed to localize the culprit artery
at the bedside of acute inferior STEMI patients before primary percutaneous coronary
intervention, allowing immediate decisions about therapy.
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Article Info
Publication History
Published online: June 07, 2016
Accepted:
June 1,
2016
Received in revised form:
May 29,
2016
Received:
March 29,
2016
Footnotes
☆Sources of grants: This work was supported by grants from The National Natural Science Foundation of China (nos. 81100132 and 81170138 ), the Fundamental Research Funds for the Central Universities (no. 1191320117 ), and the First Affiliated Hospital of XJTU Fund (No. 2015yk26 ).
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