Correlation of severity of ST segment elevation with respect to the site of right coronary artery lesion
1Department of Cardiology, National Academy of Medical Sciences (NAMS), Bir Hospital, Kathmandu, Nepal.
Insights
Electrocardiogram (ECG) reliably differentiates between right coronary and left circumflex artery lesions in acute inferior myocardial infarction. ST segment elevation severity in inferior leads correlates with lesion proximity in the right coronary artery.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Electrocardiogram (ECG) is a readily available tool for predicting the infarct-related artery in acute inferior wall myocardial infarction.
- ST segment elevation severity on ECG may correlate with lesion proximity in the right coronary artery.
Purpose of the Study:
- To evaluate the diagnostic accuracy of ECG in differentiating between right coronary artery (RCA) and left circumflex artery (LCx) lesions in patients with acute inferior wall myocardial infarction.
- To assess the correlation between the severity of ST segment elevation on ECG and the proximity of lesions within the RCA.
Main Methods:
- Retrospective study of patients with acute ST-segment elevation inferior wall myocardial infarction who underwent coronary angiography.
- Comparison of ECG findings between patients with RCA versus LCx lesions.
- Analysis of ST segment elevation severity in relation to the specific site of coronary artery lesion.
Main Results:
- Of 50 patients, 42 (84%) had RCA lesions and 8 (16%) had LCx lesions.
- ECG findings such as ST elevation in lead III > II, ST depression in lead aVL > I, and ST elevation in lead V4R correlated with RCA lesions.
- A significant correlation (P<0.01) was found between the sum of ST elevation in inferior leads and lesion proximity in the RCA (proximal, mid, distal).
Conclusions:
- ECG is a reliable tool for differentiating between RCA and LCx lesions in acute inferior myocardial infarction.
- The extent of ST segment elevation in inferior leads on ECG is a valuable predictor of lesion proximity within the right coronary artery.
Introduction:
Electrocardiogram a widely available tool may predict infarct related artery in acute inferior wall myocardial infarction. Severity of ST segment elevation may correlate with proximity of lesion in right coronary artery.
Methods:
Patient with acute ST segment elevation inferior wall myocardial infarction who underwent coronary angiogram was studied. Differences in electrocardiogram among right coronary and left circumflex groups were evaluated. Severity of ST segments elevation in relation to site of lesion in right coronary was studied.
Results:
The mean age of presentation was 59.52 ± 11.01 years. Total 36 (72%) were men. A total of 42 (84%) had lesion in right and 8 (16%) in left circumflex. Age, sex,diabetes,hypertension, smoking, dyslipidemia and physical activity showed no correlation with lesion in right or circumflex coronary artery. ST segment elevation in III>II (P=0.01), ST segment depression in AVL> I (P<0.01) and ST elevation in V4R (P=0.04), correlated with right coronary lesion. Sum of ST elevation in inferior leads were 10.90 ±1.30 mm for proximal, 7.38±1.19 mm for mid and 5.50± 0.53 mm for distal right coronary with significant correlation (P<0.01).
Conclusions:
Electrocardiogram was reliable tool to difference right and left circumflex lesion. Severity of sum of ST segment elevations in inferior leads correlated with the proximity of lesion in right coronary.
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