Evaluation of Different ECG Parameters to Predict the Culprit Artery and Site of Occlusion in Patient with Acute Inferior Wall Myocardial Infarction
Cardiology and Cardiovascular Research
Volume 1, Issue 1, January 2017, Pages: 1-6
Received: Jan. 22, 2017;
Accepted: Feb. 8, 2017;
Published: Mar. 1, 2017
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Omar Samir Sedik, Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Ashraf Mohammed Anwar, Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Ashraf Al-Amir Abd Elfattah, Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Ali Ali Ramzy, Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Mamdouh Helmy Eltahan, Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
The determination of infarct related artery in acute inferior myocardial infarction (MI) is extremely important. The present study aimed to evaluate the use of different ECG criteria to predict the culprit artery and site of occlusion in patients with acute inferior wall MI. The study conducted 100 patients (51.3±10.2 yrs, 79% males) presented by acute inferior MI. All patients were subjected to surface 12-lead ECG. Four ECG criteria were analyzed for prediction of culprit artery; ST segment depression in lead aVR >1 mV, ST segment elevation in lead III more than lead II, ST segment depression in lead I >0.05 mV and ST segment elevation in lead V4R > 1mV. The sum of ST segment elevation in lead II, III and aVF and ST segment elevation in lead V4R > 1mV were analyzed to predict the site of occlusion. Patients were divided into 2 groups based on the angiographic definition of the culprit artery: Group I included 79 patients (79%) with RCA lesion and Group II included 20 patients (20%) with LCX lesion. Only 1 patient (1%) was excluded because he had normal coronary angiography. In Group I, the ST segment elevation in lead III greater than lead II and ST segment depression in lead I > 0.05 mm had a comparable sensitivity (78% and 71% respectively) and specificity (60%. and 65% respectively) for RCA as the culprit artery. The ST segment elevation ≥ 1mm in V4R had very low sensitivity (37%) and highest specificity (100%). In Group II, ST segment depression ≥ 1mm in aVR was the best criteria for LCX as the culprit artery with sensitivity of 60% and specificity 81%. The sum of ST segment elevation in lead II, III and aVF was higher in proximal RCA (8.51±4.44mm) than both mid RCA (5.95 ± 3.06 mm) and distal RCA (5.00 ± 2.77 mm) (P value <0.001). The study concluded that it is possible to predict the culprit coronary artery in acute inferior wall MI by using the readily obtainable measures on the admission ECG.
Omar Samir Sedik,
Ashraf Mohammed Anwar,
Ashraf Al-Amir Abd Elfattah,
Ali Ali Ramzy,
Mamdouh Helmy Eltahan,
Evaluation of Different ECG Parameters to Predict the Culprit Artery and Site of Occlusion in Patient with Acute Inferior Wall Myocardial Infarction, Cardiology and Cardiovascular Research.
Vol. 1, No. 1,
2017, pp. 1-6.
Boersma E, Mercado N, Poldermans D et al., (2003): Acute myocardial infarction. Lancet, 361: 847–858.
Reeder G, Gersh B (2000). Modern management of acute myocardial infarction. Curr Prob Cardiol; 25: 683–730.
Kosuge M, Kimura K, Ishikawa T et al. (1998): New electrocardiographic criteria for predicting the site of coronary artery occlusion in inferior wall acute myocardial infraction. Am J Cardiol.; 82: 1318–1322.
Wellens H and Conover M. (2006): The ECG in Emergency Decision Making. Elsevier, 2nd edition: 1–16.
Tierala I, Nikus K, Sclarovsky S et al. (2009): Predicting the culprit artery in acute ST-elevation myocardial infarction and introducing a new algorithm to predict infarct-related artery in inferior ST-elevation myocardial infarction: correlation with coronary anatomy in the HAAMU Trial. J Electrocardiol; 42: 120–126.
Zhong-qun Z, Wang W, Shu-yi D et al. (2009): electrocardiographic characteristics in angiographically documented occlusion of the dominant left circumflex artery with acute inferior myocardial infarction: limitations of ST elevation III/II ratio and ST deviation in lateral limb lead. Journal of Electrocardiology; 42: 432–439
Thygesen K, Alpert J, Jaffe A et al. (2012): The writing group on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction 2012,'Third universal definition of myocardial infarction. Eur Heart J.; 33: 2551-2567.
Ehrhard LR, Sjogren A and Wahlberg I. (2000): Single right-sided precordial lead in the diagnosis of right ventricular involvement in inferior myocardial infarction. Am Heart J.; 91: 571-576.
Pelter M, Adams M, and Drew B (1996): Computer versus manual measurement of ST-segment deviation. J Electrocardiol; 29: 78-82.
Lang R, Bierig M, Devereux R et al., (2006): Recommendations for chamber quantification. Eur J Echocardiogr; 7: 79–108.
Cerqueira MD, Weissman NJ, Dilsizian V et al. (2002): American Heart Association Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging: Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation; 105: 539-542.
Kaul S, Tei C, Hopkins JM et al. (2004): Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J.; 107: 526-531.
Mill MR, Wilcox BR and Anderson RH (2003): Surgical Anatomy of the Heart. In: Cohn LH. Edmunds LH Jr. (eds.) Cardiac Surgery in the Adult. New York: McGraw-Hill: 3152.
Engelen D, Gorgels A, Cheriex E et al. (1999): Value of the electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction. J Am Coll Cardiol; 34: 389-395.
Verouden N, Barwari K, Koch K et al. (2009): Distinguishing the right coronary artery from the left circumflex coronary artery as the infarct-related artery in patients undergoing primary percutaneous coronary intervention for acute inferior myocardial infarction. Euro pace; 11: 1517–1521.
Tamura A (2014). Significance of lead aVR in acute coronary syndrome. World J Cardiol.; 6 (7): 630–637.
Alherbish A, Westerhout CM, Fu Y et al. (2013). The forgotten lead: does aVR ST-deviation add insight into the outcomes of ST-elevation myocardial infarction patients? Am Heart J.; 166: 333–339.
Zimetbaum P, Mark E, Josephson A, et al (2003): Use of the Electrocardiogram in Acute Myocardial Infarction. N Engl J Med; 348: 933-940.
Chia B. L, Yip JW, Tan HC et al. (2000): Usefulness of ST elevation II/ III ratio and ST deviation in lead I for identifying the culprit artery in inferior wall acute myocardial infarction. Am J Cardiol.; 86: 341-343.
Shemirani H and Nayeri-Torshizi E (2015). Electrocardiographic characteristics of posterior myocardial infarction in comparison to angiographic findings. ARYA Atheroscler.; 11 (1): 30–35.
Correale E, battista R, Martone A et al. (1999): Electrocardiographic patterns in acute inferior myocardial infarction with and without right ventricular involvement, Clinical Cardiol; 37: 44.
Birnbaum Y, Wagner G, Barbash G, et al. (1999): Correlation of angiographic findings and right (V1 to V3) versus left (V4 to V6) precordial ST-segment depression in inferior wall acute myocardial infarction. Am J Cardiol.; 83: 143–148.
Fiol M, Carrillo A, Cygankiewicz I et al. (2004): New criteria based on ST changes in 12-leads surface ECG to detect proximal versus distal right coronary artery occlusion in the case of acute infero-posterior myocardial infarction. Ann Noninvasive Electrocardiol.; 9: 383-388.
Iqbal, M, Azhar M, Aved M et al. (2008): Study on ST- segment elevation acute myocardial infarction in diabetic and non-diabetic patients. Pak. J. Med. Sci., 24: 786–791.
Kanei Y, Sharma J, Diwan R et al. (2010): 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. 43 (2): 132-135.
Sun T, Wang L, and Zhang Y; (2007): The value of ECG leads aVR in the differential diagnosis of acute inferior wall myocardial infarction. Intern Med; 46: 795–799.
Wong TW, Huang XH, Liu W et al. (2004): New electrocardiographic criteria for identifying the culprit artery in inferior wall acute myocardial infarction-usefulness of T-wave amplitude ratio in leads II/III and T-wave polarity in the right V5 lead. Am J Cardiol.; 94: 1168-1171.
Jim M, Tsui K, Yiu Fu K et al. (2012): Jeopardized Inferior Myocardium (JIM) Score: An Arithmetic Electrocardiographic Score to Predict the Infarct-Related Artery in Inferior Myocardial Infarction. Ann Acad Med Singapore 2012; 300-304.
Erdem A, Yilmaz MB, Yalta k et al. (2007): The severity of ST segment elevation in acute inferior myocardial infarction: Does it predict the presence of a proximal culprit lesion along the right coronary artery course? Anadolu kardiyol Derg; 7: 189-190.
Naqvi M, Ali M, Hakeem F et al. (2008): Correlation of severity of ST segment in acute inferior wall myocardial infarction with the proximity of Rigft coronary artery disease. J Ayub Med Coll Abbottabad; 20 (4): 82-85.