Identifying the culprit artery via 12-lead electrocardiogram in inferior wall ST-segment elevation myocardial
Peng Zhou1, Yingying Wu1, Meng Wang2
1Department of Cardiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Insights
Identifying the culprit artery in inferior wall ST-segment elevation myocardial infarction (STEMI) is crucial. Simple ECG methods using double leads, like STE in III > II, offer superior accuracy and convenience over complex algorithms.
Area of Science:
- Cardiology
- Medical Diagnostics
- Electrocardiography
Background:
- Inferior wall ST-segment elevation myocardial infarction (STEMI) often results from acute occlusion of the right coronary artery (RCA) or left circumflex artery (LCX).
- Accurate localization of the culprit artery in inferior wall STEMI using 12-lead ECG is essential for timely and effective treatment.
- Existing diagnostic properties of various ECG-based methods for lesion localization in inferior wall STEMI require further recognition and comparison.
Approach:
- A comprehensive meta-analysis was conducted to evaluate and compare the diagnostic performance of different 12-lead ECG methods for identifying culprit arteries in inferior wall STEMI.
- Pooled sensitivity, specificity, area under the curve (AUC), and diagnostic odds ratio (DOR) were calculated for each diagnostic method.
- Thirty-three studies involving 4414 participants were included in the meta-analysis.
Key Points:
- Methods utilizing double leads demonstrated superior diagnostic properties compared to complex algorithms.
- ST-segment elevation (STE) in lead III > II showed high pooled sensitivity (0.89) and AUC (0.88).
- ST-segment depression (STD) in lead aVL > I and the ratio of STD V3/STE III ≤1.2 also exhibited strong diagnostic potential.
Conclusions:
- Diagnostic methods employing double leads are more effective for culprit artery identification in inferior wall STEMI.
- The combination of STE in lead III > II and STD in lead aVL > I is recommended as an ideal method due to its accuracy and simplicity.
- Complex diagnostic algorithms, such as Jim score, Fiol's, and Tierala's, were found to be less effective than simpler double-lead ECG criteria.
Background:
Inferior wall ST-segment elevation myocardial infarction (STEMI) is mostly caused by acute occlusion of right coronary artery (RCA) and left circumflex artery (LCX). Several methods and algorithms using 12-lead ECG were developed to localize the lesion in inferior wall STEMI. However, the diagnostic properties of these methods remain under-recognized.
Aims:
The aim of this meta-analysis is to compare the diagnostic properties among the methods of identifying culprit artery in inferior wall STEMI using 12-lead ECG.
Methods:
We performed a meta-analysis to calculate the pooled sensitive, specificity, area under the curve (AUC) and diagnostic odds ratio (DOR) of each method.
Results:
Thirty-three studies with 4414 participants were included in the analysis. Methods using double leads had better diagnostic properties, especially ST-segment elevation (STE) in III > II [with pooled sensitivity 0.89 (0.84-0.93), specificity 0.68 (0.57-0.79), DOR 17 (9-32), AUC 0.88 (0.85-0.91)], ST-segment depression (STD) in aVL > I [with pooled sensitivity 0.82 (0.72-0.90), specificity 0.69 (0.48-0.86), DOR 11 (4-29), AUC 0.85 (0.81-0.88)], and STD V3/STE III ≤1.2 [with pooled sensitivity 0.88 (0.78-0.95), specificity 0.59 (0.42-0.75), DOR 12 (5-27), AUC 0.82 (0.78-0.85)]. Diagnostic algorithms, including Jim score[pooled sensitivity 0.70 (0.55-0.85), specificity 0.88 (0.75-0.96)], Fiol's algorithm [pooled sensitivity 0.54 (0.44-0.62), specificity 0.92 (0.88-0.96)] and Tierala's algorithm [pooled sensitivity 0.60 (0.49-0.71), specificity 0.91 (0.86-0.96)], were not superior to these simple methods.
Conclusions:
Our meta-analysis indicated that diagnostic methods using double leads had better properties. STE in III > II together with STD in aVL > I may be the most ideal method, for its accuracy and convenience.
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