Electrocardiogram criteria of limb leads predicting right coronary artery as culprit artery in inferior wall myocardial infarction

Abstract

Background:Prior studies have proposed several electrocardiogram (ECG) criteria in limb leads for identifying the culprit coronary artery (CCA) in patients with acute inferior wall myocardial infarction (IWMI). The aim of our study was to conduct an evidence-based evaluation and test accuracy comparison of these criteria.Methods:We searched the PubMed, Embase, and Ovid. Eligible studies to assess the diagnostic performance of ECG criteria predicting CCA in IWMI were reviewed for inclusion. A diagnostic meta-analysis of bivariate approach was performed for pooled estimates of sensitivity and specificity, and meta-regression was implemented to investigate sources of heterogeneity.Results:Twenty-four studies with 4431 unique participants met the inclusion criteria. The pooled sensitivity and specificity for ST-segment elevation (STE) in III > II, ST-segment depression (STD) in I, STD in aVL, STD in aVL > I, STE in III > II, and STD in aVL > I were 0.91 (0.88–0.94) and 0.69 (0.53–0.81), 0.80 (0.73–0.87) and 0.69 (0.62–0.76), 0.90 (0.81–0.95) and 0.41 (0.22–0.62), 0.84 (0.75–0.91) and 0.72 (0.48–0.88), and 0.79 (0.62–0.90) and 1.00 (0.37–1.00), respectively. Heterogeneity investigation showed that whether multi-vessel diseased patients were excluded, sample size, publication year, etc., could influence the diagnostic performance.Conclusion:STE in III > II performed better than other criteria for predicting RCA as CCA in IWMI, and STE in III > II and STD in aVL > I were potential and simple algorithms. ECG could be an effective tool to identify the CCA, but future studies are clearly needed to address the potential of diagnostic and prognostic value.

A 56-Year-Old Female With Acute ST-Segment Elevation Myocardial Infarction, Complete Heart Block, and Hemodynamic Instability

“…In general, acute transmural inferior MI will show signs (ST-elevation) in leads II, III, and aVF. ST-segment elevation in lead III greater than II is predictive of RCA occlusion, as demonstrated by this patient [4]. It is important to identify the occluded artery to guide decisions on emergent treatment as well as PCI, considering that it is not recommended to perform PCI on uninvolved arteries [4].…”

A Simple Electrocardiographic Reading for Identifying the Culprit Site of Coronary Artery Occlusion in Inferior Wall Acute Myocardial Infarction

“…Previous reports [11][12][13][14][15]18,[23][24], more frequently used ST-segment elevation in lead III than lead II (or lead III > II) as an indicator of infarct-related coronary artery at the RCA. One recent meta-analysis also demonstrated that ST segment elevation in lead III > II provided better prediction of right coronary artery as the culprit artery in inferior myocardial infarction [28].…”

Localising culprit artery in inferior STEMI

“…Using lead III>II is an ideal algorithm to identify RCA culprit lesions as evidenced by a recent large meta-analysis. 8 This can then be augmented by additional criteria such as reciprocal ST depression in aVL and lead I to improve specificity, as a number of studies have shown. 8 …”

“… 8 This can then be augmented by additional criteria such as reciprocal ST depression in aVL and lead I to improve specificity, as a number of studies have shown. 8 …”