Department of Cardiology, Medical University of Vienna, Vienna, Austria -
Department of Cardiology, Medical University of Vienna, Vienna, Austria.
Panminerva Med. 2023 Sep;65(3):303-311. doi: 10.23736/S0031-0808.21.04398-6. Epub 2021 Nov 11.
In addition to diagnosing acute myocardial infarction (MI), the electrocardiogram (ECG) may also predict the culprit coronary artery. We aimed to assess the diagnostic accuracy of ECG algorithms predicting the occluded vessel in inferior ST-segment elevation myocardial infarction (STEMI).
This retrospective cohort study included 300 consecutive patients with inferior STEMI undergoing acute coronary angiography. A new method based on the summation of ST-segment deviations in multiple leads from the first 12-lead-ECG was used to develop algorithms to discriminate between right coronary artery (RCA) and circumflex artery (CX) occlusion. Additionally, older algorithms were reassessed.
The RCA was occluded in 235 patients (78%) and the CX in 65 (22%). ST-segment deviations differed significantly between RCA and CX occlusions in leads I, III, aVR, aVL, aVF and V1. ST-segment deviations in lead I showed the highest discriminatory ability of a single lead (area under the receiver operating curve [AUC]=0.77). The summation of multiple leads further increased the discriminatory ability ("III-II+aVF+aVR+V1:" AUC=0.86; "III-II-I+aVF+V1:" AUC=0.85). The best binary algorithm "III-II-I+aVF+V1>0.1 mV" classified 86% of cases correctly and was better than the best old algorithm (83.3%). The simpler algorithm "III+aVR+V1≥0.1 mV" still predicted 85.0% correctly. All algorithms had higher sensitivities for RCA than for CX detection and performed better in right-dominant anatomy.
A new approach summating multiple ST-segment deviations generated ECG algorithms with higher diagnostic accuracy to predict the occluded vessel in inferior STEMI compared to previous studies. These algorithms may facilitate earlier risk stratification for patients at risk of postinfarct complications.
除了诊断急性心肌梗死（MI）外，心电图（ECG）也可以预测罪犯冠状动脉。我们旨在评估心电图算法预测下壁 ST 段抬高型心肌梗死（STEMI）闭塞血管的诊断准确性。
本回顾性队列研究纳入了 300 例连续行急性冠状动脉造影的下壁 STEMI 患者。采用一种新的方法，即从首次 12 导联心电图的多个导联中叠加 ST 段偏移，来开发区分右冠状动脉（RCA）和回旋支（CX）闭塞的算法。此外，还重新评估了旧算法。
235 例（78%）患者 RCA 闭塞，65 例（22%）患者 CX 闭塞。在 I、III、aVR、aVL、aVF 和 V1 导联中，RCA 和 CX 闭塞之间的 ST 段偏移有显著差异。单个导联的 ST 段偏移显示出最高的鉴别能力（接受者操作特征曲线下面积[AUC]=0.77）。多个导联的叠加进一步提高了鉴别能力（“III-II+aVF+aVR+V1：AUC=0.86；III-II-I+aVF+V1：AUC=0.85”）。最佳的二进制算法“III-II-I+aVF+V1>0.1 mV”正确分类了 86%的病例，优于最佳的旧算法（83.3%）。更简单的算法“III+aVR+V1≥0.1 mV”仍正确预测了 85.0%的病例。所有算法在 RCA 检测方面的敏感性均高于 CX 检测，在右优势型解剖结构中表现更好。
与之前的研究相比，一种新的方法汇总多个 ST 段偏移生成了心电图算法，以提高诊断准确性来预测下壁 STEMI 中的闭塞血管。这些算法可能有助于对有梗死后并发症风险的患者进行早期风险分层。
