New electrocardiographic criteria for predicting the site of coronary artery occlusion in inferior wall acute myocardial infarction

Kosuge, Masami; Kimura, Kazuo; Ishikawa, Toshiyuki; Hongo, Yoichiro; Mochida, Yasuyuki; Sugiyama, Mitsugi; Tochikubo, Osamu

doi:10.1016/s0002-9149(98)00634-1

Cited by 62 publications

(46 citation statements)

References 15 publications

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“…The importance of ECG changes and their relationship with the IRA was recognized in the 1980s (9). Since then, numerous studies have described various ECG criteria to identify the IRA in patients with inferior-wall STEMI (7)(8)(9)(10)(11)(12). It should be noted that lead aVR has traditionally received less attention in clinical evaluation among all ECG leads, probably because it is directionally nonadjacent to any other ECG lead (4).…”

Section: Discussionmentioning

confidence: 99%

“…Overall, the sensitivity of existing ECG criteria ranges from 84% to 96% for RCA and 21% to 86% for the LCx. Similarly, the specificity of the existing ECG criteria ranges from 40% to 78% for RCA and 72% to 98% for the LCx (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). These data indicate that the existing criteria already have good sensitivity for RCA and good specificity for LCx localization, while the specificity for RCA and sensitivity for LCx ranges from poor to fair.…”

Section: Discussionmentioning

confidence: 99%

“…These algorithms are simple and user friendly, focusing on one or two leads (3). In acute STEMI patients, the criteria for predicting the culprit artery are usually based on the analysis of ST-segment elevation and ST-segment depression in different leads (6)(7)(8). These criteria in isolation have shown good sensitivity for the RCA and good specificity for the LCx in previous studies (9)(10)(11)(12).…”

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confidence: 99%

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PREdiction of ST deviations in lead aVR as a noninvasive tool to predict the infarct-Related coronary artery in patients with acute Inferior-wall Myocardial Infarction (The PREST-RIMI Study)

Sinha¹,

Mishra²

2016

Curr Res Cardiol

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BACKgROunD: Acute myocardial infarction is one of the most common presentations of coronary artery disease (CAD). Although coronary angiography remains the gold standard for identification of the infarctrelated artery (IRA), conventional 12-lead electrocardiography (ECG) is an essential tool for diagnosis, risk stratification and prognosis. If specific ECG patterns can be recognized, it will be possible to determine the IRA and size of the ventricular area that is jeopardized. The existing ECG algorithms have good sensitivity for the right coronary artery (RCA) and good specificity for the left circumflex artery (LCx) as predictors of IRA in patients with acute inferior-wall myocardial infarction (IWMI), while the specificity for the RCA and sensitivity for the LCx are modest. OBjECTIVE: To evaluate deviations in lead aVR to predict IRA in patients with IWMI, and to validate several commonly used 12-lead ECG characteristics. METhODS: A total of 585 consecutive patients with a first occurrence of acute IWMI were analyzed for the association between ECG and IRA diagnosed using coronary angiography. Subsequently, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of depression in lead aVR, along with various commonly used ECG criteria for predicting the IRA, were estimated using coronary angiographic findings as the gold standard. RESuLTS: The RCA and the LCx were found to be the IRA in 415 (71%) and 170 (29%) patients, respectively. It was observed that the absence of ST depression in lead aVR, ST depression in lead I ≥0.5 mm, ST depression in lead aVL >1 mm and ST elevation in lead III > ST elevation in lead II had excellent sensitivity and specificity in predicting the RCA as the culprit vessel. Similarly, ST depression in lead aVR ≥0.5 mm, the ratio of ST depression in lead V3 to ST elevation in lead III >1.2 had excellent sensitivity and specificity in predicting the LCx as the culprit vessel. COnCLuSIOn: These findings reveal that evaluation of ST deviations in lead aVR offers good sensitivity and specificity for LCx and RCA occlusions. The authors believe that using multiple ECG criteria may provide earlier and better identification of the IRA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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PREdiction of ST deviations in lead aVR as a noninvasive tool to predict the infarct-Related coronary artery in patients with acute Inferior-wall Myocardial Infarction (The PREST-RIMI Study)

Sinha¹,

Mishra²

2016

Curr Res Cardiol

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“…Lead III used to have the highest STsegment elevation in acute RCA occlusion. 9 If the cut-off point is set at ≥2.5 mm in lead III, it has a reasonably fair sensitivity (53%) and specificity (88%). The comparison of clinical and ECG features between types A and B angiographic pattern was performed using patients with RCA as the infarct-related artery, because they had a relatively larger number of patients (type 1B only had 1 patient).…”

Section: Discussionmentioning

confidence: 99%

Angiographic and Clinical Implications of Combined ST‐segment Elevation in Anterior and Inferior Leads in Acute Myocardial Infarction

Jim¹,

Chan²,

Tang³

et al. 2009

Clinical Cardiology

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Background:The clinical and angiographic findings of patients suffered from acute myocardial infarction (MI) and presented with combined ST elevation in both anterior and inferior leads remain unclear. Hypothesis: These patients might have ≥1 coronary arteries occluded. Methods: From January 2002 to December 2006, 49 consecutive patients were found to have ST elevation in both anterior and inferior leads during myocardial infarction. Patients who had left circumflex artery occlusion (acute or chronic) were excluded. These patients were divided into 4 types according to the infarct-related artery (IRA) and status of the contralateral vessel patency: left anterior descending artery (LAD) as the IRA with a patent right coronary artery (RCA) (type 1A, n = 25); LAD as IRA with an occluded RCA (type 1B, n = 1); RCA as IRA with a patent LAD (type 2A, n = 19); and RCA as IRA with an occluded LAD (type 2B, n = 4). Results: Single vessel occlusion (type A angiographic pattern) was found in 90% of patients. Type 1A patients had a larger infarct size than that of 2A. ST elevation in V 2 ≥ V 3 identified RCA as the IRA with a high specificity (92%) and sensitivity (74%). Type 2B patients (2-vessel occlusion) had a larger infarct size than that of 2A; however, no electrocardiogram (ECG) criteria could reliably differentiate them. Conclusion: In a real world situation, single vessel occlusion is found in the majority of cases of combined ST elevation in anterior and inferior leads. ST elevation in V 2 ≥ V 3 distinguishes RCA against LAD as the IRA with high accuracy.

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“…Right ventricular involvement in patients with acute iSTEMI, diagnosed by the presence of ST-segment elevation in right-sided precordial leads, is reported to have a higher rate of major complications and in-hospital mortality (7)(8)(9)(10). Several studies have proposed ECG criteria to aid diagnosis of proximal right coronary artery (RCA) occlusion in patients with iSTEMI from the standard 12-lead ECG (8,(11)(12)(13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

The Utility of the Standard 12-Lead Electrocardiogram in the Prediction of Proximal Right Coronary Artery Occlusion in Acute Inferior Myocardial Infarction

Styliadis

Ziakas

Karvounis

et al. 2008

The Journal of Emergency Medicine

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New electrocardiographic criteria for predicting the site of coronary artery occlusion in inferior wall acute myocardial infarction

Cited by 62 publications

References 15 publications

PREdiction of ST deviations in lead aVR as a noninvasive tool to predict the infarct-Related coronary artery in patients with acute Inferior-wall Myocardial Infarction (The PREST-RIMI Study)

PREdiction of ST deviations in lead aVR as a noninvasive tool to predict the infarct-Related coronary artery in patients with acute Inferior-wall Myocardial Infarction (The PREST-RIMI Study)

Angiographic and Clinical Implications of Combined ST‐segment Elevation in Anterior and Inferior Leads in Acute Myocardial Infarction

The Utility of the Standard 12-Lead Electrocardiogram in the Prediction of Proximal Right Coronary Artery Occlusion in Acute Inferior Myocardial Infarction

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