ISSN: 2451-0629
Archives of Medical Science - Atherosclerotic Diseases
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Official journal of the International Lipid Expert Panel (ILEP)
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1/2020
vol. 5
 
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abstract:
Clinical research

The accuracy of distribution of non-ST elevation electrocardiographic changes in localising the culprit vessel in non-ST elevation myocardial infarction

Kristina Gifft
1
,
Rugheed Ghadban
2
,
Nina Assefa
3
,
Zachary Luebbering
3
,
Haytham Allaham
4
,
Tariq Enezate
5

1.
Department of General Medicine, University of Missouri Health Care, Columbia, MO, USA
2.
Division of Cardiology, Washington University, St Louis, MO, USA
3.
Division of Cardiovascular Medicine, University of Missouri Health Care, Columbia, MO, USA
4.
Division of Cardiology, University of Maryland, Baltimore, MD, USA
5.
Division of Cardiology, University of California Log Angeles-Harbor Medical Center, Los Angeles, CA, USA
Arch Med Sci Atheroscler Dis 2020; 5: e226–e229
Online publish date: 2020/09/10
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Introduction
ST-segment elevation distribution on electrocardiogram (ECG) in patients presenting with ST-elevation myocardial infarction (STEMI) accurately localises the culprit vessel. However, the utility of the ECG changes in localising the coronary culprit territory in the setting of non-ST segment elevation myocardial infarction (NSTEMI) is not well established.

Material and methods
This study included patients presenting with NSTEMI, who had dynamic non-ST elevation ischaemic changes in one or more ECG leads and underwent percutaneous coronary intervention (PCI) in a single vessel between October 2011 and November 2017 in a single university hospital institution. The accuracy, sensitivity, and specificity of the distribution of ECG changes in localising the culprit vessel were calculated.

Results
There was a total of 82 patients included in this study, who received PCI to the left anterior descending (LAD), right coronary artery (RCA), and left circumflex (LCX), in 43.9%, 24.4%, and 31.7%, respectively; 51% were male. In this cohort, sensitivity of ECG in localising single-culprit-vessel NSTEMI was 41.5%. The overall accuracy of ECG changes was 50.0%, 72.0%, and 70.0% in LAD, RCA, and LCX distribution, respectively. The sensitivity and specificity were 72.2% and 32.6% in LAD distribution, 20% and 88.7% in RCA distribution, and 15.4% and 82.1% in LCX distributions, respectively.

Conclusions
Ischaemic non-ST elevation ECG changes had modest accuracy in localising the culprit vessel in patients with PCI-treated NSTEMI. These changes were more sensitive in LAD distribution and more specific in RCA and LCX distributions.

keywords:

non-ST elevation ischaemic changes, non-ST segment elevation myocardial infarction, coronary angiogram, culprit vessel

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