Predicting the infarct-related artery in STEMI from the surface ECG: independent validation of proposed criteria

Eerdekens, Rob; Chavez, Jose F.; Fox, Janis H.; Flaherty, James; Dekker, Lukas; Johnson, Nils P.

doi:10.4244/eij-d-17-00345

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…In our case, successful cannulation of both left and right coronary ostium was achieved despite a severe RAS. Standard 12 lead ECG has modest diagnostic accuracy for identifying the infarct-related artery [6]. A dedicated radial catheter can correctly identify the culprit vessel, more importantly in the setting of inferior myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

Can Tiger (TIG) Catheters Be a Solution to the Radial Artery Spasm (RAS) in Coronary Angioplasty? A Case-Based Report of Successful Reperfusion With the Use of 5-French (Fr) TIG Catheter and Literature Review

Khan¹,

Besis²,

Upadhyaya³

et al. 2022

Cureus

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Conventionally, during a primary percutaneous coronary intervention (PPCI), a diagnostic catheter is used to visualize the contralateral coronary system from the site of the acute occlusion. For that purpose, Judkins Right 4 (JR4) or Judkins Left 3.5 (JL3.5) diagnostic catheters are usually preferred, depending on the ECG findings. On the other hand, the use of a dedicated diagnostic catheter in the setting of PPCI is supported only by evidence extrapolated from coronary angiography on patients with stable coronary artery disease. We present a case of a 46-year-old patient who presented with ST-segment elevation myocardial infarction (STEMI) and underwent successful PPCI. A 6-French (Fr) radial sheath was placed in the right radial artery. Due to the presence of ST-segment elevation in both the inferior as well as in the anterior precordial leads, raising the possibility of a wrap-around left anterior descending (LAD) artery as the infarct-related artery, a 5-Fr Tiger (TIG) diagnostic catheter was initially used for cannulation of the left coronary system. The culprit lesion was identified in the proximal part of a small second right ventricular (RV) branch where it was 100% occluded with thrombus and the patient had a successful PPCI.

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Section: Discussionmentioning

confidence: 99%

Can Tiger (TIG) Catheters Be a Solution to the Radial Artery Spasm (RAS) in Coronary Angioplasty? A Case-Based Report of Successful Reperfusion With the Use of 5-French (Fr) TIG Catheter and Literature Review

Khan¹,

Besis²,

Upadhyaya³

et al. 2022

Cureus

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“…10,11 Severe LAD obstruction causes myocardial ischaemia and angina. 12 When coronary flow is compensated by the collateral circulation, repolarization abnormalities caused by reperfusion injury result in T-wave symmetrical inversion or biphasic T-waves in the precordial leads. 10 A study conducted by Migliore et al, 13 showed that myocardial oedema rather than stunning and reperfusion of the myocardium underlies the ECG changes of Wellens' syndrome.…”

Section: Discussionmentioning

confidence: 99%

Two case reports of Wellens’ syndrome

et al. 2018

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Wellens’ syndrome is characterised by particular changes in electrocardiogram (ECG) precordial lead T-waves accompanied by proximal stenosis of the left anterior descending (LAD) artery. Two cases of electrocardiographic changes associated with Wellens’ syndrome are presented here. Case 1, a 55-year-old female, was transferred to the First Affiliated Hospital of Xi’an Jiaotong University with intermittent and laborious angina pectoris. Her first ECG on admission revealed T-wave inversion in leads V1–V3 and biphasic T-waves in V4. Case 2, an 85-year-old female, presented with dyspnoea and paroxysmal chest pain. Her admission ECG displayed asymmetrical T-wave inversion in leads V1–V3, I, and aVL, and depressed ST segments in leads V2–V5. In this patient, drug-eluting stents were placed on a LAD artery lesion and right coronary artery occlusion. The potential of ECGs to aid decision-making in severe myocardial infarction is straightforward, particularly in patients with characteristic ECGs, however, Wellens’ syndrome has a wide spectrum of clinical manifestations and the ECG patterns may manifest itself persistently over a period of weeks. Therefore, ECG parameters should be combined with coronary angiography to confirm the presence of lesions.

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“…Likewise, when ST depression (STD) in aVL derivation is higher than DI derivation (aVL> DI) culprit artery is more likely to be RCA. [7][8][9][10] Diagnosis of inferior STEMI was made in patients with ST-segment elevation of more than 1 mm in at least two of DII, DIII or aVF derivations. 5 In patients with ST-segment depression in V1 and V2, posterior leads were placed and V7-9 obtained in order to diagnose concomitant posterior STEMI.…”

Section: Ecg Criteriamentioning

confidence: 99%

İnferior ST-segment elevasyonlu miyokard enfarktüsü hastalarında infarkt ile ilişkili damarın öngörülmesinde EKG kriterleri ve koroner arter baskınlığının EKG üzerine etkisi

Durmaz¹,

Karadağ²,

Ebren³

et al. 2020

Sakarya Medical Journal

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Objective Previous studies reported the distribution of ST elevation (STE) may predict the infarct related artery (IRA). However, the impact of coronary dominance on ECG is not clearly demonstrated. Our primary aim was to investigate the impact of coronary dominance on the distribution of STE. Materials and Methods We retrospectively included patients with inferior STEMI. Previously defined ECG predictors of IRA were tested; higher STE in DIII>DII or presence of ST depression in aVL and/or DI presumes right coronary artery (RCA); STE in DII>DIII presumes left circumflex artery (LCX). Results Our study encompasses 192 patients. The culprit artery was RCA in 151 patients and LCX in 41 patients. The sensitivity and specificity of STE DIII>DII for prediction of RCA were 84% and 35% respectively. In comparison, the sensitivity of STE DII>DIII for prediction of LCX was lower, whereas specificity was considerably higher (48% and 65%, respectively). However, the best sensitivity was observed with a STE DIII>DII,which strongly predicts the coronary dominance with a sensitivity of 97% and a specificity of 27 %. If the IRA is RCA the magnitude of STE was significantly higher when the reference point was QRS onset (p: 0.021) compared to the prior guideline recommendations. However, this significance was not observed in patients with LCX occlusion (p: 0.212). Conclusion In this study, we have demonstrated that ECG predictors of IRA are significantly related to coronary dominance. Moreover, new ECG criteria increased the diagnostic ability of ECG when RCA is the culprit artery but did not differ when the LCX is the IRA.

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Predicting the infarct-related artery in STEMI from the surface ECG: independent validation of proposed criteria

Cited by 4 publications

References 18 publications

Can Tiger (TIG) Catheters Be a Solution to the Radial Artery Spasm (RAS) in Coronary Angioplasty? A Case-Based Report of Successful Reperfusion With the Use of 5-French (Fr) TIG Catheter and Literature Review

Can Tiger (TIG) Catheters Be a Solution to the Radial Artery Spasm (RAS) in Coronary Angioplasty? A Case-Based Report of Successful Reperfusion With the Use of 5-French (Fr) TIG Catheter and Literature Review

Two case reports of Wellens’ syndrome

İnferior ST-segment elevasyonlu miyokard enfarktüsü hastalarında infarkt ile ilişkili damarın öngörülmesinde EKG kriterleri ve koroner arter baskınlığının EKG üzerine etkisi

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