Correlation of severity of ST segment elevation in acute inferior wall myocardial infarction with the proximity of right coronary artery disease (original) (raw)
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Bangladesh Heart Journal
Background & objective: Involvement of the right coronary artery frequently occurs in acute inferior myocardial infarction. Typical ECG changes in this condition involve ST-segment elevation in inferior leads. The present study was intended to predict the site of the lesion in the right coronary artery (RCA) in patients with acute inferior wall myocardial infarction using the height of ST-segment elevation as the predictor variable. Methods: The present cross-sectional study was carried out in the Department of Cardiology, National Institute Cardiovascular Diseases (NICVD), Dhaka, Bangladesh over a period of one year between July 2010 to June 2011. Patients with acute inferior myocardial infarction admitted to CCU of NICVD within 12 hours of the onset of chest pain and underwent coronary angiography within 4 weeks of acute myocardial infarction (AMI) were the study population. With the help of a 12-lead ECG, magnitudes of ST-segment elevation in leads II, III, and aVF were measured....
Cardiology and cardiovascular research, 2017
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 V 4 R > 1mV. The sum of ST segment elevation in lead II, III and aVF and ST segment elevation in lead V 4 R > 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 V 4 R 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.
IOSR Journals , 2019
Introduction: Classifying the location of an occlusion in the culprit artery during ST-elevation myocardial infarction is important for risk stratification to optimize treatment. Objectives: To compare the validity of echocardiographic parameters assessing right ventricular (RV) function for the prediction of proximal right coronary artery (RCA) lesion in patients with inferior wall myocardial infarction. Methods: The study included 76 patients after their first episode of acute inferior myocardial infarction with significant RCA lesion (43 patients with proximal RCA stenosis and 33 patients with distal RCA stenosis). Full echocardiographic examination was done before revascularization, including RV dimension, tricuspid annular plane systolic excursion, and tissue Doppler imaging of RV free wall at the level of the tricuspid annulus and recording the following variables: peak systolic velocity (Sm), peak early diastolic velocity, peak late diastolic velocity, ejection time (ET), isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT), and myocardial performance index (MPI), which was calculated as (MPI = IVRT + IVCT/ET). Results: Patients with proximal RCA showed significantly lower Sm (10.44 ± 2.61 cm/s vs. 12.11 ± 2.94 cm/s, p = 0.013) and shorter ET (224.18 ± 49.96 ms vs. 280.90 ± 46.12 ms, p = 0.001). While IVRT, IVCT, and MPI were significantly higher (95.25 ± 19.22 ms vs. 68.48 ± 12.77 ms, p = 0.001; 81.62 ± 23.59 ms vs. 60.90 ± 17.38 ms, p = 0.001; and 0.82 ± 0.222 vs. 0.47 ± 0.10, p = 0.001, respectively) when compared with patients with distal RCA stenosis. Multiple regression analysis including (tricuspid annular plane systolic excursion, Sm, and MPI) showed that the most independent predictors for proximal RCA lesions were MPI (p = 0.0001). The receiver operator characteristic curve for MPI showed areas under the curve of 97% and a confidence interval of 93%. A cutoff value of 0.58 for MPI had a sensitivity of 95% and specificity of 97% for the diagnosis proximal RCA. Conclusions: The most independent predictors for proximal RCA lesion is MPI.
Cardiovascular Journal, 1970
Background: The patient with inferior wall AMI, site of culprit lesions is an important determinant of outcome. Patient with RV infarction have a poor prognosis whereas those with occlusion of LCX have a good prognosis. Early diagnosis and treatment substantially reduce cardiac events particularly in high-risk patients. V4R can be used as to locate the site of obstruction. Materials and methods: 81 patients with acute inferior myocardial infarction admitted to the coronary care unit (CCU) within 12 hours after the onset of chest pain who underwent coronary angiogram were included in the study. Standard 12-lead ECG with right precordial lead V4R was recorded. Patients were categorized into within 3 groups according to early changes of V4R-Group- I - ST-segment elevation > 1 mm and positive T- wave, Group-II- ST-segment iso-electric and positive T-wave, Group-III- ST-segment depression >1 mm and negative T -wave. Results: In group I patients, highest percentage of the patients h...
Volume 7 • Issue 2 91 (Only) were found 5%, 8%, another 5% and 3% respectively whereas cases with normal vessels were found 10%. Finally, in assessing the vessel involvement we found DVD in more than one third (35%) of total patients. Besides this, cases with SVD and TVD were found in 28% and 26% respectively. Conclusion: It is possible to predict the culprit artery whether right coronary artery or left circumflex artery by examining the surface electrocardiography in patient with inferior myocardial infarction. A higher ST segment elevation in lead III than in lead II and deeper ST segment depression in aVL of surface ECG is the most useful parameters for predicting the RCA culprit artery in acute inferior wall myocardial infarction.
Journal of Clinical and Preventive Cardiology, 2017
The objective of this study was to assess diagnostic accuracy of the ECG localization of culprit vessel occlusion site and compare it with coronary angiographic findings. This study analyzed 180 cases that came with acute myocardial infarction to cardiology department of Tanta University Hospital in a period from the first of May 2016 up to the end of May 2018. Typical chest pain lasting more than 30 minutes accompanied by ST-elevation at the J-point in two contiguous leads associated with elevation of cardiac markers were included in this study but we exclude patients with Previous history of myocardial infarction, Previous history of coronary artery bypass graft (CABG) surgery, ECG evidence of left bundle branch block (LBBB), preexcitation, paced rhythm and acute coronary syndrome other than STEMI. Among all myocardial infarction patients, ECG shows left anterior descending (LAD) branch affection in 116/180 patients (64.44%), which was as follow; 13.33% proximal to S1, 6.67% proximal to D1 and 44.44% distal to D1. Right coronary artery (RCA) presented in 56/180 patients (31.11%) as follow; 11.11% proximal to RV branch and 20% distal to RV branch. Left circumflex artery (LCX) is represented only in 8/180 patients (4.44%). ECG is an easily and widely available inexpensive tool which helps in the routine clinical practice to categorize and optimize STEMI patients by detection of artery occluded into either right coronary artery or left anterior descending coronary artery or left circumflex coronary artery as the infarcted related culprit vessel and predict the possible complication K e y w o r d s
The Egyptian Heart Journal, 2014
Background: In patients with acute ST-segment elevation myocardial infarction identification of the culprit artery either due to right coronary artery or left circumflex artery was studied. The electrocardiogram can help in earlier risk stratification and better guidance of therapy for reperfusion. Patients and methods: 50 patients with acute inferior myocardial infarction were divided into two groups. Group A: patients with ST segment depression in lead aVR P 1 mv. Group B: patients with isoelectric ST segment or with ST segment depression in lead aVR < 1 mv. All patients were subjected to coronary angiography, and echocardiograghy. Results: Fifty patients with acute inferior myocardial infarction were included in the present study. There were 35 males (70%) and 15 females (30%), with a mean age 55.6 ± 8.8. In Group A, left circumflex artery was the culprit artery in 8 (47%) and right coronary artery was the culprit artery in 9 (53%). Group B, left circumflex artery was the culprit artery in 4 (12%) and right coronary artery was the culprit artery in 29 (88%) patients with aVR depression had significantly larger infarctions (estimated by peak creatine phosphokinase (CPK-MB) levels and transthoracic echocardiography) than patients without aVR depression.
American Journal of Cardiology, 2004
Acute myocardial infarction (AMI) of the inferoposterior wall is due to occlusion of the right coronary artery (RCA) or the left circumflex (LCx) coronary artery. The outcome of patients depends mainly on the culprit artery. Therefore, the presumptive prediction of a culprit artery based on the electrocardiogram recorded at admission is of clinical importance. The aim of this study was to develop a sequential algorithm based on the "ups and downs" of the ST segment in different leads to predict the culprit artery (RCA vs LCx) in cases of inferoposterior AMI. We analyzed electrocardiographic and angiographic findings of 63 consecutive patients with an evolving AMI with ST elevation in the inferior leads , and aVF) and a single-vessel occlusion. Specificity, sensitivity, and positive and negative predictive values of different electrocardiographic criteria (ups and downs of the ST segment) were studied individually and in com-bination to find an algorithm that would best predict the culprit artery. The following electrocardiographic criteria were included in the 3-step algorithm: (1) ST changes in lead I, (2) the ratio of ST elevation in lead III to that in lead II, and (3) the ratio of the sum of ST depression in precordial leads to the sum of ST elevation in inferior leads [(¥ ¥ 2ST in leads V 1 to V 3 )/(¥ ¥ 1ST in leads II, III, and aVF)]. Application of this sensitive algorithm suggested the location of the culprit coronary artery (RCA vs LCx) in 60 of 63 patients (>95%). The few patients in whom this algorithm did not work were those with a very dominant LCx that presented ST depression of >0.5 mm in lead I. In conclusion, careful sequential analysis of an electrocardiogram of an inferoposterior AMI with ST elevation may lead to the identification of a culprit artery. ᮊ2004
Medical journal of the Islamic Republic of Iran, 2014
In addition to diagnosing the acute myocardial infarction (MI), stratifying high-risk patients and proper treatment strategies are important issues in managing patients complaining of chest pain and suspecting MI. Many studies have been conducted to predict the occlusion site by interpreting the ST segment deviations in Electrocardiogram (ECG).Additional posterior and right precordial leads are suggested in literature to increase the sensitivity of prediction. The goal of this study was to determine the relation of ST segment changes in ECG (conventional 12 leads ECG besides right and posterior leads) with the site of occlusion within the vessel. Retrospectively, from total 138 patients, 76 of them were analyzed as single vessel acute Inferior ST elevation Myocardial infarction (I-STEMI)-ST which 56 (74%) had Right Coronary Artery (RCA) occlusion [22(29.3%) proximal RCA, 24(32%) middle RCA and 10(13.3%) distal occlusion of RCA], 19(25%) had Left Circumflex artery (LCx) lesion and on...
Panacea Journal of Medical Sciences, 2023
Abstract Background: Acute myocardial infarction (AMI) is one of the most common diagnoses in hospitalized patients in industrialized countries. The early (30-day) mortality rate from AMI is ~30%, with more than half of these deaths occurring before the stricken individual reaches the hospital.When patients present with acute coronary syndrome, The 12-lead electrocardiogram (ECG) recorded by the alarmed general practitioner or ambulance staff is a pivotal diagnostic and triage tool since it is at the center of the decision pathway for management. In this study the accuracy of ECG in identifying the culprit artery was determined by comparing ECG finding with angiography finding which is a direct visualization procedure. Aim: To assess the value of electrocardiogram in predicting the culprit artery in acute ST elevation MI and correlating with coronary angiogram finding. Materials and Methods: A Cross Sectional Observational study was carried out for a period of 11months from February 2021 to December 2021 among 100 Patients admitted to ICCU, Dept of Cardiology, King George Hospital, Visakhapatnam who were diagnosed with acute ST-elevation myocardial infarction. The accuracy of ECG in identifying the culprit artery was determined by comparing ECG finding with angiography finding which is a direct visualization procedure. Results: The sensitivity of ECG in predicting LAD as infarct related artery when compared to CAG, which was taken as standard test is 94.10%, specificity 89.79% the positive predictive value is 90.56% and the negative predictive value is 93.61%. Conclusion: In the present study, ECG well correlated with CAG (90.56%) in predicting LAD as infarct related artery. Keywords: Electrocardiogram, Coronary angiogram, Culprit artery in acute ST elevation MI