Correlation between electrocardiographic changes and coronary findings in patients with acute myocardial infarction
Abdallah Sanaani1, Srikanth Yandrapalli2, George Jolly2
1Division of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Insights
Electrocardiogram (ECG) abnormalities correlate with coronary artery disease (CAD) location in ST-elevation myocardial infarction (STEMI) patients. In non-ST-elevation myocardial infarction (NSTEMI), ECG findings are less consistent but can predict left anterior descending artery disease.
Area of Science:
- Cardiology
- Medical Diagnostics
- Clinical Research
Background:
- ST-segment elevation on ECG reliably predicts coronary territory in ST-elevation myocardial infarction (STEMI).
- Correlation between ECG abnormalities and coronary artery disease (CAD) location is less established in non-ST-elevation myocardial infarction (NSTEMI).
- Understanding this correlation is crucial for accurate diagnosis and treatment planning in NSTEMI patients.
Purpose of the Study:
- To investigate the correlation between electrocardiographic (ECG) abnormalities and the location of single-vessel obstructive coronary artery disease (CAD).
- To compare these correlations in both STEMI and NSTEMI patient cohorts.
- To determine the predictive value of ECG findings for specific coronary artery blockages in NSTEMI.
Main Methods:
- Retrospective review of coronary angiography data from 2012.
- Inclusion of patients with single obstructive CAD, angina-equivalent symptoms, and elevated cardiac troponin I.
- ECG interpretation by a cardiologist blinded to angiography results, excluding patients with bundle branch block or pacing.
Main Results:
- Anterior STEMI (29 patients) showed 100% correlation with left anterior descending (LAD) artery disease.
- Inferior STEMI (18 patients) was associated with right coronary artery (RCA) or left circumflex (LCX) artery disease (78% and 17%, respectively).
- In NSTEMI (102 patients), 52% had definite ECG ischemic abnormalities; anterior changes predicted LAD disease (97%), and inferior changes predicted RCA/LCX disease (64% and 23%).
Conclusions:
- Anterior STEMI strongly indicates LAD obstructive CAD.
- Inferior STEMI suggests a high likelihood of RCA or LCX obstructive CAD.
- ECG abnormalities in NSTEMI are less frequent but, when present, can predict the location of single-vessel CAD, particularly LAD disease with anterior changes.
Background:
Correlation of ST-segment elevation on the 12-lead electrocardiogram (ECG) with the expected affected coronary territory is established in patients with ST-elevation myocardial infarction (STEMI). In patients with non-ST-elevation myocardial infarction (NSTEMI), correlation of ischemic ECG abnormalities with the affected coronary territory has not been well-established. We sought to investigate the correlation of electrocardiographic abnormalities with the location of 1-vessel obstructive coronary artery disease (CAD) in patients with both STEMI and NSTEMI.
Methods:
In this retrospective study, the charts of all patients referred for coronary angiography in 2012 were reviewed. Patients with a single obstructive coronary artery plus angina-equivalent symptoms and an elevated cardiac troponin I was included. Available ECGs were interpreted by an experienced cardiologist (WSA) blinded to the result of angiography. Patients with complete bundle branch block or ventricular pacing were excluded. Ischemic ECG changes were correlated to a coronary territory based on predefined criteria.
Results:
Of 131 included patients (mean age 64±13 years; 74% male), 29 had STEMI and 102 had NSTEMI. Eleven of 11 patients (100%) with anterior STEMI had left anterior descending artery (LAD) obstructive CAD. Of 18 patients with inferior STEMI, 14 (78%) had right coronary artery (RCA) obstructive CAD, 3 (17%) had left circumflex artery (LCX) artery obstructive CAD, and 1 (5%) had LAD obstructive CAD. Of 102 NSTEMI patients, 53 (52%) had definite ECG ischemic abnormalities. Of 31 patients with anterior definite ECG ischemic abnormalities, 30 (97%) had LAD obstructive CAD, and 1 (3%) had RCA obstructive CAD. Of 22 patients with inferior definite ECG ischemic abnormalities, 14 (64%) had RCA obstructive CAD, 5 (23%) had LCX obstructive CAD, and 3 (14%) had LAD obstructive CAD.
Conclusions:
Patients with anterior STEMI had LAD obstructive CAD. Patients with inferior STEMI were highly likely to have RCA or LCX obstructive CAD. Only half of NSTEMI patients had definite ischemic ECG abnormalities. When present, anterior ischemic ECG changes in patients with single vessel CAD with NSTEMI were predictive of LAD obstructive CAD.
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