The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis

Birnbaum, Yochai; Drew, Barbara J.

doi:10.1136/pmj.79.935.490

Cited by 90 publications

(62 citation statements)

References 147 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…дования КА, своевременно подготовить необходи-мые расходные материалы, а также предупредить осложнения, ассоциированные с поражением того или иного коронарного сосуда. Рядом исследовате-лей созданы алгоритмы диагностики топического поражения КА по показателям стандартной ЭКГ [3,4], однако они являются несколько громоздкими и сложными для использования в реальной клини-ческой практике. Целью исследования было улучшение диагно-стики ИМпST у пациентов с однососудистым пора-жением КА с помощью стандартной электрокардио-графии.…”

Section: Discussionunclassified

“…Показатели чувствительности и специфичности при тестировании созданного алгоритма диагностики окклюзированной артерии при ИМпST находились в диапазоне 50-75%, что несколько меньше, чем в ана-логичных исследованиях [3,4,7]. В частности, в иссле-довании Birnbaum Y, et al (2003) элевация ST в I, AVL и депрессия ST в III, AVF при окклюзии проксималь-ной части ПМЖА имели чувствительность 76% и спе-цифичность 81%.…”

Section: Discussionunclassified

See 1 more Smart Citation

Topical Diagnostics of Single Coronary Artery Occlusion in St Elevation Myocardial Infarction Patients

Хафизов¹,

Zagidullin²,

Лакман³

et al. 2017

Russ J Cardiol

View full text Add to dashboard Cite

В диагностике инфаркта миокарда с подъёмом сегмента (ИМпSt) основную роль играют электрокардиография (ЭкГ), которая позволяет определить не только наличие самого инфаркта миокарда, но, во многих случаях, и лока-лизацию окклюзии. Цель. Изучение эффективности топической диагностики поражения коронар-ных артерий при ИМпSt с однососудистым поражением с помощью ЭкГ. Материал и методы. Были исследованы 200 пациентов (59,9±0,93 лет) с ИМпSt с однососудистым поражением коронарных артерий. Оценена точность диагно-стики локализации коронарной окклюзии в трёх коронарных артериях и в 2-х сегментах в каждой из них с помощью созданного алгоритма диагностики. Результаты. Создан алгоритм диагностики многососудистого поражения трёх коронарных артерий, позволяющий проводить топическую диагностику пора-жения передней межжелудочковой артерии (чувствительность 92,2% и специ-фичность 96,5%), правой коронарной артерии (92,3% и 95,1%) и, в меньшей степени, огибающей артерии (81,5% и 66,7%), а также 2-х секторов в каждой из них с чувствительностью 48,8-66,7% и специфичностью 60,0-74,5%. Заключение. При ИМпSt созданы алгоритм, а также программа, позволяю-щая рассчитать риск окклюзии конкретной коронарной артерии и её сегмен-тов, а также риск летального исхода. Results. An algorithm invented, for diagnostics of multivessel disease of three coronary arteries, that makes it to perform topical diagnostics of the left anterior descending artery (sensitivity 92,2% and specificity 96,5%), of the right coronary artery (92,3% and 95,1%) and, at lesser grade, of the circumflex artery (81,5% and 66,7%), as two sectors in each of them with sensitivity 48,8-66,7% and specificity 60,0-74,5%. Российский Conclusion.In SteMI, an algorithm invented, and the software that calculates risk of occlusion of an exact coronary artery and its segments, as the risk of fatal outcome. Как известно, инфаркт миокарда (ИМ) можно диагностировать при обнаружении увеличения кар-диоспецифического тропонина и одного из следую-щих признаков: кардиалгии, новых изменений на электрокардиограмме (ЭКГ), в том числе патоло-гического зубца Q и визуального подтверждения некроза миокарда [1]. За многие годы использова-ния ЭКГ не утратила своего значения в диагностике ИМ, особенно ИМ с подъёмом ST (ИМпST). Пока-затели ЭКГ способны показать не только локализа-цию пораженной стенки миокарда, но и выявить топику пораженной коронарной артерии (КА) и даже уровень окклюзии [2]. Возможность опреде-ления локализации поражения позволит улучшить точность диагностики, увеличить скорость приня-тия решений, определить первоочередность обсле- Russ

show abstract

Section: Discussionunclassified

Topical Diagnostics of Single Coronary Artery Occlusion in St Elevation Myocardial Infarction Patients

Хафизов¹,

Zagidullin²,

Лакман³

et al. 2017

Russ J Cardiol

View full text Add to dashboard Cite

show abstract

“…On the other hand, the LCx emits various obtuse marginal branches to supply blood to the posterior part of the inferoposterior as well as posterolateral wall. As a result, the vector of injury current is directed more to the right and inferior in RCA occlusions, and more to the left and posterior in LCx occlusions (14,15). We strongly believe that this minor difference in vector direction forms the basis of ECG differentiation between RCA and LCx occlusions.…”

Section: Discussionmentioning

confidence: 99%

PREdiction of ST deviations in lead aVR as a noninvasive tool to predict the infarct-Related coronary artery in patients with acute Inferior-wall Myocardial Infarction (The PREST-RIMI Study)

Sinha¹,

Mishra²

2016

Curr Res Cardiol

View full text Add to dashboard Cite

BACKgROunD: Acute myocardial infarction is one of the most common presentations of coronary artery disease (CAD). Although coronary angiography remains the gold standard for identification of the infarctrelated artery (IRA), conventional 12-lead electrocardiography (ECG) is an essential tool for diagnosis, risk stratification and prognosis. If specific ECG patterns can be recognized, it will be possible to determine the IRA and size of the ventricular area that is jeopardized. The existing ECG algorithms have good sensitivity for the right coronary artery (RCA) and good specificity for the left circumflex artery (LCx) as predictors of IRA in patients with acute inferior-wall myocardial infarction (IWMI), while the specificity for the RCA and sensitivity for the LCx are modest. OBjECTIVE: To evaluate deviations in lead aVR to predict IRA in patients with IWMI, and to validate several commonly used 12-lead ECG characteristics. METhODS: A total of 585 consecutive patients with a first occurrence of acute IWMI were analyzed for the association between ECG and IRA diagnosed using coronary angiography. Subsequently, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of depression in lead aVR, along with various commonly used ECG criteria for predicting the IRA, were estimated using coronary angiographic findings as the gold standard. RESuLTS: The RCA and the LCx were found to be the IRA in 415 (71%) and 170 (29%) patients, respectively. It was observed that the absence of ST depression in lead aVR, ST depression in lead I ≥0.5 mm, ST depression in lead aVL >1 mm and ST elevation in lead III > ST elevation in lead II had excellent sensitivity and specificity in predicting the RCA as the culprit vessel. Similarly, ST depression in lead aVR ≥0.5 mm, the ratio of ST depression in lead V3 to ST elevation in lead III >1.2 had excellent sensitivity and specificity in predicting the LCx as the culprit vessel. COnCLuSIOn: These findings reveal that evaluation of ST deviations in lead aVR offers good sensitivity and specificity for LCx and RCA occlusions. The authors believe that using multiple ECG criteria may provide earlier and better identification of the IRA.

show abstract

“…15 or 18 leads ECG should be performed to correctly diagnose culprit artery in inferior wall MI. ST elevation in inferior and posterior leads (V7, V8 and V9) is usually associated with occlusion of the left circumflex artery with the involvement of large infarct zone and complications [3,4]. ECG detection of posterior infarction is associated with concomitant ST depression in leads V1 to V3.…”

mentioning

confidence: 99%

Clinical Significance of ST Segment Elevation in Posterior Leads V7, V8 and V9 in Patients with Acute Inferior Wall Myocardial Infarction

Pradhan¹,

Sun²,

Shrestha³

et al. 2013

J Cardiovasc Dis Diagn

View full text Add to dashboard Cite

IntroductionECG diagnosis of a posterior wall myocardial infarction is difficult to diagnose through the standard 12 lead ECG, especially in the acute stage. The posterior wall MI may occur as an isolated event or often associated with an inferior wall myocardial infarction Posterior leads V7, V8 and V9 are usually ignored but it is suggested that these leads can provide ECG information that is useful for characterization of inferior AMI and diagnosis of posterior wall MI [1,2]. 15 or 18 leads ECG should be performed to correctly diagnose culprit artery in inferior wall MI. ST elevation in inferior and posterior leads (V7, V8 and V9) is usually associated with occlusion of the left circumflex artery with the involvement of large infarct zone and complications [3,4]. ECG detection of posterior infarction is associated with concomitant ST depression in leads V1 to V3. However these changes are neither sensitive nor specific [5][6][7].The aim of our study was to assess the ST segment elevation in posterior leads V7, V8, V9 for the identification of IRA and the diagnosis of posterior wall MI. We also dealt with relation of ratio of ST elevation in lead II and lead III to assess the culprit IRA for the patient with inferior wall MI. MethodsFor the retrospective study, we had collected 355 patients having an acute inferior wall MI admitted in the cardiovascular department of the First Hospital of Jilin University. The patient's data were collected from Januar, 2011 to December, 2011. Only 121 patients (male 102 and female 19) met our inclusion criteria which include chest pain lasting for more than 30 minutes before hospital admission, elevation of creatinine kinase (CK-MB) greater than twice the upper limit (normal: 0-3.5 ng/ml) and the ECG shows ST segment >0.1 mV (1mm) in at least 2 of 3 the inferior leads (II, III and aVF). The patients excluded from the study who had previous history of acute myocardial infarction, coronary artery bypass surgery or percutaneous coronary intervention prior to current hospitalization, evidence of recent left bundle branch block or left ventricular hypertrophy in ECG, and significant stenosis in both LCX and RCA or triple vessel disease so that a single infarct related artery could not be defined. ElectrocardiographyECG was recorded in all patients at a paper speed of 25 mm/s and voltage 10 mm/mv. For inferior STEMI, the inclusion criteria are ST elevation > 0.1 mV in at least two of three inferior leads (II, III and aVF).In addition to standard 12 leads, three posterior chest leads V7 to V9 should be recorded for the study. Posterior leads are recorded on the same horizontal plane as lead V6 more specifically, lead V7 on the posterior axillary line, lead V8 on the posterior scapular line AbstractObjectives: The aim of the study was to assess the role of ST segment elevation in the Posterior leads V7, V8, and V9 for the diagnosis of acute posterior wall infarction and the identification of infarct related artery (IRA) in patients with acute inferior wall MI. Background:The posterio...

show abstract

The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis

Cited by 90 publications

References 147 publications

Topical Diagnostics of Single Coronary Artery Occlusion in St Elevation Myocardial Infarction Patients

Topical Diagnostics of Single Coronary Artery Occlusion in St Elevation Myocardial Infarction Patients

PREdiction of ST deviations in lead aVR as a noninvasive tool to predict the infarct-Related coronary artery in patients with acute Inferior-wall Myocardial Infarction (The PREST-RIMI Study)

Clinical Significance of ST Segment Elevation in Posterior Leads V7, V8 and V9 in Patients with Acute Inferior Wall Myocardial Infarction

Contact Info

Product

Resources

About