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Cardiology Insights 2019
Journal of Heart and Cardiovascular Research
ISSN: 2576-1455
Page 45
March 07-08, 2019
Berlin, Germany
New Horizons in Cardiology
& Cardiologists Education
22
nd
International Conference on
J Heart Cardiovasc Res 2019, Volume 3
DOI: 10.21767/2576-1455-C1-003
The benefit of the 17-lead ECG in the acute phase of inferior
STEMI in predicting the culprit artery
Mekhdoul, Talamali, Messai
and
Bouame
Service of Cardiology,HCA
Background & Objective
: Acute coronary syndromes
with ST segment elevation in inferior territory are due to
the occlusion of either the right coronary artery (RCA) or
circumflex artery (CX). The prediction of the culprit artery
based on the electrocardiogram at admission is not
always easy for the clinician. The objective of this study
was to evaluate the benefit of 17-lead ECG on admission
in predicting the culprit artery in the inferior IDM.
Methodology &Theoretical Orientation
: We selected and
analyzed retrospectively 17-lead ECG of 113 patients.
Those ECG were made at the first medical contact in
patients consulting before the sixth hour of the onset of
chest pain and whose coronary angiography performed
within 24 hours found mono-truncal lesions. We
calculated sensitivities, specificities and positive and
negative predictive values of ST segments of different
leads individually and in combination, which enabled us
to create an algorithm that could best predict the culprit
artery in the STEMI inferior topography. Our algorithm
includes the following electrocardiographic criteria: The
first step, look if there’s a right ventricle involvement by
examining the V3R and V4R leads, predictive of occlusion
of the RCA. The second step, separately analyze the lone
inferior STEMI (STE in D2, D3 and aVF) and the inferior
STEMI extended to the posterior wall (STE in D2, D3, aVF
and V7, V8, V9). In the lone inferior STE: two ECG criteria
are used, form of ST segment in D1 and aVL. In the
posterior wall extension case 3 criteria: (1) the ratio of the
sum of ST elevation in the inferior leads (D2, D3, aVF) to
that sum in the back leads (V7, V8, V9) then (2) the ratio
of the ST elevation D2/D3 and finally (3) the appearance
of ST segment in D1. We applied this algorithm on 236
consecutive inferior STEMI, we identified correctly
225/236 (95.3%) culprit arteries, including those with
very dominant circumflex arteries. The 11 patients
misclassified by our algorithm, showed multi-truncal
lesionsandcoronarographieswereperformed repeatedly.
Conclusion&Significance
:An17leadselectrocardiogram
during the acute phase of an inferior STEMI allows a
detailed analysis of the waveform and hence, lead to the
identification of the culprit artery.