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Correlation between index electrocardiographic patterns and pre-intervention angiographic findings: insights from the

Ivan C Rokos1, Michael E Farkouh, James Reiffel

  • 1UCLA-Olive View, Department of Emergency Medicine, Los Angeles, California 91342-1495, USA. irokos@earthlink.net

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|August 2, 2011
PubMed

Insights

This study validates electrocardiogram (ECG) patterns as reliable markers for acute coronary occlusion, aiming to improve cardiac catheterization laboratory activation for myocardial infarction (MI) patients.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Tools

Background:

  • Current electrocardiogram (ECG) criteria for activating the cardiac catheterization laboratory for primary percutaneous coronary intervention (PPCI) in chest pain patients have limitations.
  • Optimizing the rate of appropriate laboratory activation remains a challenge despite existing guidelines.

Purpose of the Study:

  • To enhance the accuracy of ECG interpretation in chest pain patients before cardiac catheterization laboratory activation for PPCI.
  • To correlate ECG findings with coronary angiography to identify reliable surrogate markers for acute coronary occlusion.

Main Methods:

  • Analysis of ECG and angiographic data from 3,602 patients with chest pain consistent with myocardial infarction (MI) enrolled in the HORIZONS-AMI trial.
  • Correlation of qualifying study ECGs with baseline coronary angiograms to assess diagnostic patterns.

Main Results:

  • Left anterior descending (LAD) artery occlusion was associated with ST-segment elevation in leads V2 and V3 in over 80% of cases.
  • Right coronary artery (RCA) and left circumflex artery (LCx) were the culprit vessels in 75% and 25% of inferior MI ECG patterns, respectively.
  • Reciprocal ST-segment depression prevalence varied from 24% to 88% depending on the culprit artery, being least common for mid- and distal LAD lesions. ST-segment elevation criteria were not met in 5.3% of patients. Left main coronary occlusions showed ST-segment elevation in lead aVR in 45% of cases. Posterior MIs were not enrolled, and 25% of left bundle branch block (LBBB) cases did not undergo PCI.

Conclusions:

  • The study confirms prior vectorcardiography findings, validating specific ECG patterns as reliable indicators of acute coronary occlusion.
  • Novel insights were gained correlating index ECG ischemic changes with pre-intervention coronary angiography.
  • These findings may improve the rate of appropriate cardiac catheterization laboratory activation for acute coronary syndromes.
Abstract

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