Localising culprit artery in inferior STEMI
Background ST elevation myocardial infarction (STEMI) represents a cardiac emergency. Time to diagnosis, identification of culprit lesion, and intervention are important. Inferior STEMI represents a dilemma for cardiologists. The territory can be supplied by the right coronary artery (RCA) or the le...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-01-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/10/1/e002093.full |
| _version_ | 1797769901773946880 |
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| author | Alexandra Smith Ardalon Farhat-Sabet John E Atwood Christopher Pickett |
| author_facet | Alexandra Smith Ardalon Farhat-Sabet John E Atwood Christopher Pickett |
| author_sort | Alexandra Smith |
| collection | DOAJ |
| description | Background ST elevation myocardial infarction (STEMI) represents a cardiac emergency. Time to diagnosis, identification of culprit lesion, and intervention are important. Inferior STEMI represents a dilemma for cardiologists. The territory can be supplied by the right coronary artery (RCA) or the left circumflex coronary artery (LCx). Diagnostic algorithms have been proposed to predict the culprit artery.Methods We performed a single-centre retrospective cohort analysis of all patients admitted to our hospital from 2008 to 2020 with a diagnosis of inferior STEMI. We examined the diagnostic 12 lead ECG for quantification of ST elevation in leads II and III and compared this to culprit lesion found on angiography.Results There were 304 patients identified with STEMI in our database; 105 were found to have an inferior myocardial infarction by ECG criteria. Ninety-nine were included in our study with either RCA or LCx culprit lesions on angiography (82 males, 17 females). The average age of these patients was 64.9 years old. Sensitivity, specificity, positive predictive value and negative predictive value for ST elevation in lead II exceeding lead III predicting LCx culprit lesion was 0.32 (95% CI 0.13 to 0.57), 0.94 (95% CI 0.86 to 0.98), 0.55 (95% CI 0.29 to 0.78), 0.85 (95% CI 0.81 to 0.89), respectively. Sensitivity, specificity, positive predictive value and negative predictive value for ST elevation in lead III exceeding lead II predicting RCA culprit lesion was 0.94 (95% CI 0.86 to 0.98), 0.32 (95% CI 0.13 to 0.57), 0.85 (95% CI 0.81 to 0.89), 0.55 (95% CI 0.29 to 0.78), respectively.Conclusions In inferior STEMI, comparison of ST elevation in leads II and III can reliably predict culprit lesion artery and guide intervention.Subject indexing Culprit artery localisation, inferior stemi, ECG. |
| first_indexed | 2024-03-12T21:14:45Z |
| format | Article |
| id | doaj.art-40fba94f5f574b4c89b7e81c110013ae |
| institution | Directory Open Access Journal |
| issn | 2053-3624 |
| language | English |
| last_indexed | 2024-03-12T21:14:45Z |
| publishDate | 2023-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj.art-40fba94f5f574b4c89b7e81c110013ae2023-07-29T14:30:07ZengBMJ Publishing GroupOpen Heart2053-36242023-01-0110110.1136/openhrt-2022-002093Localising culprit artery in inferior STEMIAlexandra Smith0Ardalon Farhat-Sabet1John E Atwood2Christopher Pickett3Cardiology Service, Department of Medicine, Brooke Army Medical Center, San Antonio, Texas, USACardiology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USACardiology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USACardiology Service, Department of Medicine, Brooke Army Medical Center, San Antonio, Texas, USABackground ST elevation myocardial infarction (STEMI) represents a cardiac emergency. Time to diagnosis, identification of culprit lesion, and intervention are important. Inferior STEMI represents a dilemma for cardiologists. The territory can be supplied by the right coronary artery (RCA) or the left circumflex coronary artery (LCx). Diagnostic algorithms have been proposed to predict the culprit artery.Methods We performed a single-centre retrospective cohort analysis of all patients admitted to our hospital from 2008 to 2020 with a diagnosis of inferior STEMI. We examined the diagnostic 12 lead ECG for quantification of ST elevation in leads II and III and compared this to culprit lesion found on angiography.Results There were 304 patients identified with STEMI in our database; 105 were found to have an inferior myocardial infarction by ECG criteria. Ninety-nine were included in our study with either RCA or LCx culprit lesions on angiography (82 males, 17 females). The average age of these patients was 64.9 years old. Sensitivity, specificity, positive predictive value and negative predictive value for ST elevation in lead II exceeding lead III predicting LCx culprit lesion was 0.32 (95% CI 0.13 to 0.57), 0.94 (95% CI 0.86 to 0.98), 0.55 (95% CI 0.29 to 0.78), 0.85 (95% CI 0.81 to 0.89), respectively. Sensitivity, specificity, positive predictive value and negative predictive value for ST elevation in lead III exceeding lead II predicting RCA culprit lesion was 0.94 (95% CI 0.86 to 0.98), 0.32 (95% CI 0.13 to 0.57), 0.85 (95% CI 0.81 to 0.89), 0.55 (95% CI 0.29 to 0.78), respectively.Conclusions In inferior STEMI, comparison of ST elevation in leads II and III can reliably predict culprit lesion artery and guide intervention.Subject indexing Culprit artery localisation, inferior stemi, ECG.https://openheart.bmj.com/content/10/1/e002093.full |
| spellingShingle | Alexandra Smith Ardalon Farhat-Sabet John E Atwood Christopher Pickett Localising culprit artery in inferior STEMI Open Heart |
| title | Localising culprit artery in inferior STEMI |
| title_full | Localising culprit artery in inferior STEMI |
| title_fullStr | Localising culprit artery in inferior STEMI |
| title_full_unstemmed | Localising culprit artery in inferior STEMI |
| title_short | Localising culprit artery in inferior STEMI |
| title_sort | localising culprit artery in inferior stemi |
| url | https://openheart.bmj.com/content/10/1/e002093.full |
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