P6418The continued proficiency of artificial intelligence for interpreting EKG: single lead EKG for STEMI culprit lesion localization

Abstract

Abstract Background Traditionally, the 12-lead electrocardiogram (EKG) has been used for diagnosing ST-Elevation Myocardial Infarction (STEMI) and for identifying the culprit lesion. We have previously demonstrated the impact of combining a Single Lead approach with Artificial Intelligence (AI) to replace tasks previously dominated by the 12 lead EKG. This research explores the role of the single lead EKG in identifying a culprit lesion. Purpose To test the use of a single lead approach to accurately locate the culprit vessel. Methods An observational, retrospective, case-control study. Sample: 2,542 exclusively STEMI diagnosis EKG records that included post discharge feedback from healthcare centers, confirming diagnosis and culprit vessel (Left Main Coronary Artery [LMCA]; Left Anterior Descending [LAD]; Right Coronary Artery [RCA]; Left Circumflex Artery [LCX]; Saphenous Vein Graft [SVG]). Records excluded other patient and medical information. The sample was derived from the private International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing:detection of QRS complexes using a wavelet system, segmentation of each EKG into individual heartbeats (27,125 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented; “LCMA”, “LAD”, “CX”, “RCA”, “SVG”, and “No Information” classes were considered for each heartbeat per lead; individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample was used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVidia GTX 1070 GPU, 8GB RAM. Results Accuracy: 77.4% Lead III; Sensitivity: LMCA (Lead aVL 25%); LAD (Lead aVF 87.8%); RCA (Leads V1, V3 92.9%); LCX (Lead aVL 21.7%). Conclusions Our results yielded the dominance of a specific single lead to each culprit vessels, aVF for LAD and V1 and V3 for RCA. We continue testing with different algorithms to search for reliable results for the LMCA and LCX. Nonetheless, conjugating a Single Lead EKG with an AI-augmented algorithm enables faster and easier management for patients that present with STEMI affecting the LAD and RCA territories.