Rus Marius, Negruțiu Bianca Maria, Andronie-Cioara Felicia Liana, Pasca Georgeta, Judea Pusta Claudia Teodora, Sava Cristian, Ardelean Adriana Ioana, Popoviciu Mihaela-Simona, Staniș Claudia Elena
Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania.
Cardiology Department, Bihor Clinical Emergency Hospital, 410169 Oradea, Romania.
J Clin Med. 2025 Aug 9;14(16):5637. doi: 10.3390/jcm14165637.
The identification of the left anterior descending (LAD) artery as the culprit vessel in ST-segment elevation myocardial infarction (STEMI) is critical for rapid decision-making and targeted reperfusion. Electrocardiography (ECG) remains a vital diagnostic tool, especially in cases of no prior clinical or imaging data. This study evaluates the accuracy of 12-lead ECG in identifying LAD involvement and occlusion level, while examining the prognostic significance of proximal versus distal LAD lesions in the era of modern reperfusion techniques. Data from 382 patients with STEMI were analyzed, focusing on the correlation between specific ECG patterns, particularly ST-segment elevation in aVL and aVR, and coronary angiographic findings. The predictive performance of ECG in localizing proximal LAD lesions was assessed through sensitivity, specificity, and predictive values. Clinical outcomes at 30 days and 2.5 years were compared between patients with proximal and distal LAD occlusions. ST-segment elevation ≥ 0.5 mm in aVL or elevation in aVR, when associated with elevation in at least two contiguous precordial leads (V2-V4), demonstrated good sensitivity and predictive value for proximal LAD occlusion. Contrary to earlier studies, no significant difference in short- or long-term clinical outcomes was observed between proximal and distal LAD occlusion groups, possibly reflecting improvements in percutaneous coronary intervention (PCI) techniques and modern pharmacotherapy. The 12-lead ECG remains a valuable tool for identifying LAD as the culprit artery and approximating lesion location. However, in the era of advanced reperfusion therapy, the prognostic value of proximal LAD occlusion may be less pronounced than previously thought. These findings support a nuanced interpretation of ECG in guiding acute management without overestimating the long-term prognostic weight of lesion location alone.
确定左前降支（LAD）动脉为ST段抬高型心肌梗死（STEMI）的罪犯血管对于快速决策和靶向再灌注至关重要。心电图（ECG）仍然是一种重要的诊断工具，尤其是在没有既往临床或影像数据的情况下。本研究评估了12导联心电图在识别LAD受累及闭塞程度方面的准确性，同时探讨了在现代再灌注技术时代近端与远端LAD病变的预后意义。分析了382例STEMI患者的数据，重点关注特定心电图模式，特别是aVL和aVR导联ST段抬高与冠状动脉造影结果之间的相关性。通过敏感性、特异性和预测值评估心电图定位近端LAD病变的预测性能。比较了近端和远端LAD闭塞患者30天和2.5年的临床结局。当aVL导联ST段抬高≥0.5mm或aVR导联抬高，且至少两个相邻胸前导联（V2-V4）抬高时，对近端LAD闭塞具有良好的敏感性和预测价值。与早期研究相反，近端和远端LAD闭塞组在短期或长期临床结局方面未观察到显著差异，这可能反映了经皮冠状动脉介入治疗（PCI）技术和现代药物治疗的改善。12导联心电图仍然是识别LAD为罪犯动脉并大致确定病变位置的有价值工具。然而，在先进再灌注治疗时代，近端LAD闭塞的预后价值可能不如先前认为的那么显著。这些发现支持在指导急性治疗时对心电图进行细致解读，而不过度高估单纯病变位置的长期预后权重。
