Electrocardiographic Distinction of Left Circumflexand Right Coronary Artery Occlusion in PatientsWith Inferior Acute Myocardial Infarction
Vives-Borrás, Miquel (Institut d'Investigació Biomèdica Sant Pau)
Maestro, Alba (Institut d'Investigació Biomèdica Sant Pau)
García-Hernando, Victor (Institut d'Investigació Biomèdica Sant Pau)
Jorgensen, D. (University of Kansas Medical Center)
Ferrero-Gregori, Andreu (Institut d'Investigació Biomèdica Sant Pau)
Moustafa, A. H. (Institut d'Investigació Biomèdica Sant Pau)
Solé-Gonzalez, Eduard (Hospital del Mar (Barcelona, Catalunya))
Noriega, F. J. (Hospital Clínico San Carlos (Madrid))
Alvarez-Garcia, Jesus (Institut d'Investigació Biomèdica Sant Pau)
Cinca, Juan (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona

Data:	2019
Resum:	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.
Ajuts:	Instituto de Salud Carlos III RD12-0042-0002
Nota:	Altres ajuts: This work was supported by the Fondo Europeo de Desarollo Regional (FEDER).
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	American Journal of Cardiology, Vol. 123 Núm. 7 (january 2019) , p. 1019-1025, ISSN 1879-1913

DOI: 10.1016/j.amjcard.2018.12.026
PMID: 30658918

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