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Predicting the infarct related artery in STEMI from the surface ECG: independent validation of proposed criteria.

Research paper by Rob R Eerdekens, Jose F JF Chavez, Justin M JM Fox, James D JD Flaherty, Lukas Rc LR Dekker, Nils P NP Johnson

Indexed on: 10 May '17Published on: 10 May '17Published in: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology



Abstract

This study independently evaluated the diagnostic performance of electrocardiographic (ECG) criteria to predict the infarct related artery (IRA) in patients with an acute ST-segment elevation myocardial infarction (STEMI). While a number of ECG criteria have been proposed to predict the IRA in STEMI, many of these "rules" came from modestly sized populations and did not undergo external validation. Therefore, we evaluated popular criteria from the literature in an independent cohort.All acute STEMI cases over a 10-year period from a single hospital were retrospectively identified. We excluded patients with a missing pre-intervention ECG, irretrievable angiographic films, prior coronary artery bypass grafting, left bundle branch block, ventricular pacing, or not meeting strict STEMI criteria. After review of the angiograms for the IRA, cases with either no or multiple culprits were excluded. We included 480 subjects meeting STEMI criteria in inferior leads (192, 40%), anterior leads (184, 38%), both anterior and inferior leads (88, 18%), isolated lateral leads (9, 2%), or a posterior pattern (7, 1%). Notably, every pattern except isolated lateral STEMI included an IRA in both the right and left coronary arteries.Existing ECG criteria to predict the IRA in STEMI have modest diagnostic performance when externally validated, and lower than in the original reports. Distinguishing the level of obstruction in the left anterior descending artery remains especially challenging. Hence their use should be pragmatic when selecting an initial catheter for treating STEMI, since discordances will occur when compared to the actual angiogram.

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