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.

Background: For anticoagulation therapy of atrial fibrillation (AF) in east Asia, some off-label dose, so called “Asian Dose” of non-vitamin K antagonist oral anticoagulants (NOACs) was used concerning on the bleeding risks in these patients, such as low-dose rivaroxaban (10-15 mg once daily) or dabigatran (110-150 mg once daily). However, the efficacy of the off-label dose of NOACs remains controversial. Methods: We conducted a retrospective cohort study to compared the efficacy and safety among patients with AF in three groups: patients with the off-label dose of NOACs treatment (OFL group, dabigatran 110 mg once daily or rivaroxaban under 20 mg daily), patients with the standard dose of anti-coagulation therapy (SAG group, dabigatran 110 mg twice daily or rivaroxaban 20 mg once daily, or warfarin with international normalized ratio (INR) 2-3), and patients without non-coagulation treatment (NCG group) in east China. Results: A total of 296 patients were recruited in our study. Compared to patients in SAG group, patients in OFL group had higher risk in stroke and thromboembolism events (P=0.000). The risk of other events including major bleeding (P=0.597) was comparable in these two groups, while there was no significant difference in all-cause mortality, which were both dramatically lower than NAG group (0.52, P=0.000). Conclusions: Collectively, our results demonstrate that “Asian dose” of NOACs indeed can not bring much benefit for AF patients in east China.