Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Departament de Medicina de la Universitat Autònoma de Barcelona, Barcelona, Spain.
Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Departament de Medicina de la Universitat Autònoma de Barcelona, Barcelona, Spain.
Am J Cardiol. 2019 Apr 1;123(7):1019-1025. doi: 10.1016/j.amjcard.2018.12.026. Epub 2019 Jan 4.
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.
先前报道的心电图（ECG）标准可用于区分急性下壁 ST 段抬高型心肌梗死（STEMI）患者的左回旋支（LCCA）和右冠状动脉（RCA）闭塞，但诊断准确性有限。我们旨在开发一种新的算法来克服以前研究的局限性。对 230 例接受直接经皮冠状动脉介入治疗的急性下壁 STEMI 非选择性患者的临床、心电图和冠状动脉造影数据进行了分析。采用决策树分析建立了新的心电图算法。回顾了报告的 ECG 标准的诊断准确性。LCCA 闭塞发生在 111 例，RCA 闭塞发生在 119 例。我们开发了一个三步算法，可以识别 LCCA 和 RCA 闭塞，其敏感性为 77%，特异性为 86%，准确性为 82%，约登指数为 0.63。ROC 曲线下面积为 0.85，10 倍交叉验证后为 0.82。LCCA 闭塞的关键导联为 V3（V3 导联 ST 段压低/III 导联 ST 段抬高>1.2）和 V6（ST 段抬高≥0.1 mV 或大于 III 导联）。RCA 闭塞的关键导联为 I 和 aVL（ST 段压低≥0.1 mV）。21 项回顾性研究中有 15 项研究的 LCCA 闭塞病例少于 20 例，只有 48%进行了直接经皮冠状动脉介入治疗，并且既往梗死或多血管疾病常被排除在外。当应用于我们的研究人群时，报告的 ECG 标准的诊断准确性降低。总之，我们报告了一种简单而高度有区别的三步 ECG 算法，可区分急性下壁 STEMI 的“所有患者”中 LCCA 和 RCA 闭塞。LCCA 闭塞的关键心电图导联为 V3 和 V6，RCA 闭塞的关键导联为 I 和 aVL。
