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Electrocardiographic algorithm for assignment of occluded vessel in acute myocardial infarction
Günter Lehmann1, Claus Schmitt, Victoria Kehl
1Deutsches Herzzentrum München and I. Med. Klinik, Klinikum rechts der Isar, Technischen Universität München, Lazarettstrasse 36, D-80636 Munich, Germany. lehman@dhm.mhn.de
Background:
This study was performed to elaborate an electrocardiographic (ECG) algorithm enabling assignment of an occluded coronary artery in acute myocardial infarction (AMI).
Patients And Interventions:
In 109 patients (age, 59+/-12 years) with AMI (pain onset, 3.6+/-1.7 h), coronary angiography with PTCA/stenting of the culprit lesion was performed. The diagnosis of AMI was confirmed by emergency coronary angiography and laboratory analyses. Admission ECG parameters (amplitude of R-wave, ST-segment deviation, presence of Q-wave, deflection of T-wave) in standard 12-lead ECG plus extended (V(3)R to V(6)R and V(7-9)) leads were subjected to classification and regression tree (CART) analysis.
Results:
Continuous CART analysis assessed ST-segment deviations in V(2) and V(5)R. AMI of the left anterior descending (LAD), right coronary artery (RCA) and left circumflex coronary artery (CX) were correctly classified in 94, 64, and 91% of cases, respectively. Dichotomised CART analysis assessed ST-segment deviations in V(2), V(5)R, and aVF. True classification rates for LAD, RCA, and CX amounted to 84, 74, and 71%, respectively.
Conclusions:
Dichotomised CART analysis is a simple means of differentiation of CX from RCA occlusion during AMI.