The Diagnostic Value of 12‐Lead Electrocardiogram in Predicting Infarct‐Related Artery and Right Ventricular Involvement in Acute Inferior Myocardial Infarction

Kabakçı, Giray; Yildirir, Aylin; Yildiran, L; Batur, Mustafa Kemal; Çağrikul, R.; Özer, Orhan; Tokgözoğlu, Lâle; Oto, Ali̇; Özmen, Ferhan; Kes, Sırrı

doi:10.1111/j.1542-474x.2001.tb00113.x

Cited by 13 publications

(11 citation statements)

References 12 publications

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“…ST-segment elevation was measured at 60 milliseconds after the J-point and approximated to closest 0.5 mm. The reviewer attempted to identify the infarct-related artery using 12-lead information according to the published algorithms and criteria ( 3 - 19 ), including the presence of ST-segment elevation in at least one lateral lead with an isoelectric or elevated ST-segment in lead I for the Cx ( 3 ), the presence of ST-segment depression in leads I and aVL for the RCA ( 4 ), the higher ST-segment elevation in lead III than in lead II and the greater ST-segment depression in lead aVL than in lead I for the RCA ( 5 , 9 , 12 ), the presence of ST-segment depression in leads V1 or V2 for the Cx ( 6 ), the presence of ST-segment elevation in lead III exceeding that of lead II with ST-segment elevation in lead V1 for the RCA ( 7 ), the presence of ST-segment depression in aVR for the Cx ( 10 , 15 ), Fiol’s algorithm (ST-segment depression in lead I, ST-segment elevation in lead III higher than that in lead II, and the sum of ST-segment depression in V1 to V3 less than the sum of ST-segment elevation in the inferior leads for the RCA) ( 11 ), Tierala’s algorithm (ST-segment elevation in lead III higher than that in lead II, ST-segment elevation in V1, or isoelectric ST-segment segment in V1 but ST-segment depression in V2, ST-segment depression in aVR lower than that in lead aVL for the RCA) ( 13 ), Almansori’s scoring system for the RCA (≥ 1) ( 14 ), Huang’s algorithm (ST-segment elevation in lead III higher than that in lead II, ST-segment depression in lead I lower than that in aVL, ST-segment elevation <0.5 mm in lead I for the RCA) ( 17 ), Ruiz-Mateos’ formula (the sum of ST-segment elevation in lead III, aVF and V3 minus the sum of ST-segment elevation in lead II and V6 <0.75 mm for Cx) ( 18 ), and Aslanger-Bozbeyoğlu criterion (the absence of ST-segment elevation in V2 equal or greater than ST-segment depression in lead aVL) for the RCA ( 19 ) were calculated. Their diagnostic accuracy was estimated for the general cohort and those with both Cx and RCA lesions.…”

Section: Methodsmentioning

confidence: 99%

Does electrocardiogram help in finding culprit artery when angiogram shows both right and circumflex artery disease in inferior MI?

et al. 2020

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Objective: In a subgroup of patients with inferior myocardial infarction (MI), both the right coronary artery (RCA) and circumflex coronary artery (Cx) show potentially culprit lesions, and angiography may be insufficient to determine which artery is responsible for the clinical presentation. Although many electrocardiographic (ECG) algorithms have been proposed for identifying the infarct-related artery in patients with inferior MI, it is unclear whether the current algorithms have the discriminative power to identify the real culprit artery in these patients. Methods: The patients with the diagnosis of acute inferior MI and underwent coronary angiography were enrolled in the study. The prediction of the infarct-related artery was attempted from the admission ECG using published algorithms and criteria. For the angiographic definition of the infarct-related artery, multiple criteria were used. Results: Total 417 inferior MI cases were enrolled during the study period; the final patient population comprised of 318 patients. Forty-five patients (14.2%) had both RCA and Cx lesions on coronary angiography. Although several criteria and algorithms are able to identify the infarct-related artery in the general inferior MI population, they lose their strength in patients with both RCA and Cx lesions. Only the Aslanger-Bozbeyoğlu criterion emerges as a more powerful diagnostic test with a sensitivity, specificity, and c-statistic of 80%, 48%, and 0.650, respectively for the whole population (p<0.001) and 81%, 58%, and 0.709, respectively, for patients with both RCA and Cx lesions (p=0.019). Conclusion: The Aslanger-Bozbeyoğlu criterion is not only helpful in differentiating the infarct territory in combined inferior and anterior ST-segment elevation as previously shown, but also valuable in identifying the infarct-related artery in patients with inferior STEMI with critical lesions in both the RCA and the Cx.

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Section: Methodsmentioning

confidence: 99%

Does electrocardiogram help in finding culprit artery when angiogram shows both right and circumflex artery disease in inferior MI?

et al. 2020

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“…Kantitatif veriler ortalama, ± standart sapma; kalitatif değerler ise yüzde olarak ifade edildi. Sonuçların değerlendirilmesi için kategorik verilerde Pearson ki-kare testi veya daki ST segment çökmesinin, DI'deki ST segment çökmesinden fazla olduğu olgularda da lezyonun RCA'da olma olasılığının önemli ölçüde arttığı belirtilmektedir (9)(10)(11)(12) . DI ve aVL derivasyonlarındaki ST segment çökmeleri resiprokal değişiklikler olup enfarktüsün diğer bölgelere yayılımıyla ilişkisi yoktur (13,14) .…”

Section: İstatistiksel Analizunclassified

Can We Predict Infarct Related Coronary Arteries of Patients with Acute Inferior Myocardial Infarction from Electrocardiographic Findings?

Gül¹,

Güngör²,

Yıldız³

et al. 2013

Kosuyolu Kalp Derg

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Introduction: We aimed to investigate the role of electrocardiography (ECG) findings in determining infarct related coronary arteries of patients hospitalized with a diagnosis of acute inferior myocardial infarction (AIMI).Patients and Methods: The first ECG records taken on admission to hospital and demographic characteristics of 132 patients, who were followed with the diagnosis of AIMI (mean age, 57.3 ± 11, 118 men) in our center between January 2004-January 2009, were evaluated.Results: When coronary angiography were evaluated, it was detected that the infarct-related coronary artery (IRCA) was the right coronary artery (RCA) in 70.4% of all patients, whereas it was circumflex artery (Cx) in 29.6% respectively. It was detected that DIII-ST elevation was higher than DII (94.6% sensivity, and 75.9% specifity, p= 0.001) and there was st depression in aVL and DI leads in cases which IRCA was RCA (88.2% sensivity and 75.2% specifity, p= 0.011). Although ST depression in aVL lead was higher than st depression in DI in cases which RCA was IRCA, this finding was defined statistically significant (%95.7 sensivity; %73.6 specifity; p= 0.016). RCA was the IRCA significantly in patients with inferior wall MI accompanied by right ventricular myocardial infarction (p= 0.005). Although Cx was observed as the culprit artery in cases which was accompanied by posterior wall infarction, no statistically finding was detected (p= 0.3). ST-depression was detected in V1-2 leads in ECG of patients whose culprit artery was Cx (%84.6 sensitivity, %36.3 specificity, p= 0.009).Conclusion: The findings based on surface ECG of the patients who underwent AIMI shows that IRCA can be predicted

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“…First is the lack of information regarding the right precordial leads (particularly V4R), which have an established role in determining RCA as the culprit artery in IWMI (2). Also, our database lacks information about Q waves, U waves and QRS morphology that has previously been used to differentiate the RCA from the left circumflex artery as the culprit artery in IWMIs (13)(14)(15).…”

Section: Limitationsmentioning

confidence: 99%

Electrocardiographic identification of the culprit coronary artery in inferior wall ST elevation myocardial infarction

Almansori

Armstrong

et al. 2010

Canadian Journal of Cardiology

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The Diagnostic Value of 12‐Lead Electrocardiogram in Predicting Infarct‐Related Artery and Right Ventricular Involvement in Acute Inferior Myocardial Infarction

Abstract: We concluded that 12-lead ECG is a cheap, easy, and readily obtainable diagnostic approach in discrimination of IRA and its culprit lesion segment. However, despite high specificity, due to moderate degree sensitivity, its value for the diagnosis of RVMI is questionable.

Cited by 13 publications

References 12 publications

Does electrocardiogram help in finding culprit artery when angiogram shows both right and circumflex artery disease in inferior MI?

Does electrocardiogram help in finding culprit artery when angiogram shows both right and circumflex artery disease in inferior MI?

Can We Predict Infarct Related Coronary Arteries of Patients with Acute Inferior Myocardial Infarction from Electrocardiographic Findings?

Electrocardiographic identification of the culprit coronary artery in inferior wall ST elevation myocardial infarction

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