Evaluation of electrocardiographic algorithms in the assessment of the infarct-related artery in acute myocardial infarction

Abstract

Objectives — In acute myocardial infarction, it is of great value to identify the infarct-related artery and the site of occlusion in a coronary artery (proximal versus distal).This study assessed the diagnostic value of two previously published electrocardiographic algorithms to identify the infarctrelated artery and the site of occlusion in anterior and inferior acute myocardial infarction.Methods and results — We studied retrospectively a group of 88patients with a first myocardial infarction.We determined the infarct-related artery using the electrocardiographic algorithms on the electrocardiogram at the time of admission and compared these results with the angiographically determined infarct-related artery.The best electrocardiographic algorithm could determine the infarct-related artery in an inferior myocardial infarction as the left circumflex coronary artery and as the proximal and distal right coronary artery with a sensitivity of 63%, 67% and 80%, respectively, and a specificity of 100%, 82% and 69%, respectively. One algorithm was unable to diagnose a left circumflex coronary artery occlusion. In an anterior myocardial infarction the best electrocardiographic algorithm could determine the infarct-related artery as the proximal and distal left anterior descending coronary artery with a sensitivity of 85% and 80%, respectively, and with a specificity of 77% and 82%, respectively.Conclusion — In acute myocardial infarction the use of electrocardiographic algorithms is helpful to predict the site of occlusion and can play a crucial role in the care of patients.