Electrocardiographic Distinction of Left Circumflex and Right Coronary Artery Occlusion in Patients With Inferior Acute Myocardial Infarction

Previously reported electrocardiographic (ECG) criteria to distinguish left circumflex (LCCA) and right coronary artery (RCA) occlusion in patients with acute inferior ST-segment elevation myocardial infarction (STEMI) afford a modest diagnostic accuracy. We aimed to develop a new algorithm overcomi...

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Autores: Vives-Borras, M, Maestro, A, Garcia-Hernando, V, Jorgensen, D, Ferrero-Gregori, A, Moustafa, AH, Sole-Gonzalez, E, Noriega, FJ, Alvarez-Garcia, J, Cinca, J
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2019
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p2772
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=2772
http://ddd.uab.cat/record/223331
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spelling Electrocardiographic Distinction of Left Circumflex and Right Coronary Artery Occlusion in Patients With Inferior Acute Myocardial InfarctionVives-Borras, MMaestro, AGarcia-Hernando, VJorgensen, DFerrero-Gregori, AMoustafa, AHSole-Gonzalez, ENoriega, FJAlvarez-Garcia, JCinca, JPreviously reported electrocardiographic (ECG) criteria to distinguish left circumflex (LCCA) and right coronary artery (RCA) occlusion in patients with acute inferior ST-segment elevation myocardial infarction (STEMI) afford a modest diagnostic accuracy. We aimed to develop a new algorithm overcoming limitations of previous studies. Clinical, ECG, and coronary angiographic data were analyzed in 230 nonselected patients with acute inferior STEMI who underwent primary percutaneous coronary intervention. A decision-tree analysis was used to develop a new ECG algorithm. The diagnostic accuracy of reported ECG criteria was reviewed. LCCA occlusion occurred in 111 cases and RCA in 119. We developed a 3-step algorithm that identified LCCA and RCA occlusion with a sensitivity of 77%, specificity of 86%, accuracy of 82%, and Youden index of 0.63. The area under the ROC curve was 0.85 and resulted 0.82 after a 10-fold cross validation. The key leads for LCCA occlusion were V3 (ST depression in V3/ST elevation in III >1.2) and V6 (ST elevation >= 0.1 mV or greater than III). The key leads for RCA occlusion were I and aVL (ST depression >= 0.1 mV). Fifteen of 21 reviewed studies had less than 20 cases of LCCA occlusion, only 48% performed primary percutaneous coronary intervention, and previous infarction or multivessel disease were often excluded. The diagnostic accuracy of reported ECG criteria decreased when applied to our study population. In conclusion, we report a simple and highly discriminative 3-step ECG algorithm to differentiate LCCA and RCA occlusion in an "all comers" population of patients with acute inferior STEMI. The diagnostic key ECG leads were V3 and V6 for LCCA and I and aVL for RCA occlusion. (C) 2019 The Authors. Published by Elsevier Inc.EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC2019info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=2772http://ddd.uab.cat/record/223331AMERICAN JOURNAL OF CARDIOLOGYISSN: 00029149ISSNe: 18791913reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p27722026-06-14T12:41:47Z
dc.title.none.fl_str_mv Electrocardiographic Distinction of Left Circumflex and Right Coronary Artery Occlusion in Patients With Inferior Acute Myocardial Infarction
title Electrocardiographic Distinction of Left Circumflex and Right Coronary Artery Occlusion in Patients With Inferior Acute Myocardial Infarction
spellingShingle Electrocardiographic Distinction of Left Circumflex and Right Coronary Artery Occlusion in Patients With Inferior Acute Myocardial Infarction
Vives-Borras, M
title_short Electrocardiographic Distinction of Left Circumflex and Right Coronary Artery Occlusion in Patients With Inferior Acute Myocardial Infarction
title_full Electrocardiographic Distinction of Left Circumflex and Right Coronary Artery Occlusion in Patients With Inferior Acute Myocardial Infarction
title_fullStr Electrocardiographic Distinction of Left Circumflex and Right Coronary Artery Occlusion in Patients With Inferior Acute Myocardial Infarction
title_full_unstemmed Electrocardiographic Distinction of Left Circumflex and Right Coronary Artery Occlusion in Patients With Inferior Acute Myocardial Infarction
title_sort Electrocardiographic Distinction of Left Circumflex and Right Coronary Artery Occlusion in Patients With Inferior Acute Myocardial Infarction
dc.creator.none.fl_str_mv Vives-Borras, M
Maestro, A
Garcia-Hernando, V
Jorgensen, D
Ferrero-Gregori, A
Moustafa, AH
Sole-Gonzalez, E
Noriega, FJ
Alvarez-Garcia, J
Cinca, J
author Vives-Borras, M
author_facet Vives-Borras, M
Maestro, A
Garcia-Hernando, V
Jorgensen, D
Ferrero-Gregori, A
Moustafa, AH
Sole-Gonzalez, E
Noriega, FJ
Alvarez-Garcia, J
Cinca, J
author_role author
author2 Maestro, A
Garcia-Hernando, V
Jorgensen, D
Ferrero-Gregori, A
Moustafa, AH
Sole-Gonzalez, E
Noriega, FJ
Alvarez-Garcia, J
Cinca, J
author2_role author
author
author
author
author
author
author
author
author
description Previously reported electrocardiographic (ECG) criteria to distinguish left circumflex (LCCA) and right coronary artery (RCA) occlusion in patients with acute inferior ST-segment elevation myocardial infarction (STEMI) afford a modest diagnostic accuracy. We aimed to develop a new algorithm overcoming limitations of previous studies. Clinical, ECG, and coronary angiographic data were analyzed in 230 nonselected patients with acute inferior STEMI who underwent primary percutaneous coronary intervention. A decision-tree analysis was used to develop a new ECG algorithm. The diagnostic accuracy of reported ECG criteria was reviewed. LCCA occlusion occurred in 111 cases and RCA in 119. We developed a 3-step algorithm that identified LCCA and RCA occlusion with a sensitivity of 77%, specificity of 86%, accuracy of 82%, and Youden index of 0.63. The area under the ROC curve was 0.85 and resulted 0.82 after a 10-fold cross validation. The key leads for LCCA occlusion were V3 (ST depression in V3/ST elevation in III >1.2) and V6 (ST elevation >= 0.1 mV or greater than III). The key leads for RCA occlusion were I and aVL (ST depression >= 0.1 mV). Fifteen of 21 reviewed studies had less than 20 cases of LCCA occlusion, only 48% performed primary percutaneous coronary intervention, and previous infarction or multivessel disease were often excluded. The diagnostic accuracy of reported ECG criteria decreased when applied to our study population. In conclusion, we report a simple and highly discriminative 3-step ECG algorithm to differentiate LCCA and RCA occlusion in an "all comers" population of patients with acute inferior STEMI. The diagnostic key ECG leads were V3 and V6 for LCCA and I and aVL for RCA occlusion. (C) 2019 The Authors. Published by Elsevier Inc.
publishDate 2019
dc.date.none.fl_str_mv 2019
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=2772
http://ddd.uab.cat/record/223331
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=2772
http://ddd.uab.cat/record/223331
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
publisher.none.fl_str_mv EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
dc.source.none.fl_str_mv AMERICAN JOURNAL OF CARDIOLOGY
ISSN: 00029149
ISSNe: 18791913
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
repository.name.fl_str_mv
repository.mail.fl_str_mv
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