Prediction of totally occluded culprit artery from presenting electrocardiogram in acute coronary syndrome

Abstract

Background: Revascularization strategy in acute coronary syndrome is based on the ST segment deviation in the presenting ECG. ST segment elevation denotes total occlusion of culprit vessel and mandates early revascularization. Aim: To study the correlation of totally occluded coronary vessel with ST segment elevation in presenting 12 lead ECG. Material and Methods: The present study was conducted in 89 consecutive patients with chestpain and angiogram evidence of at least one totally occluded epicardial coronary vessel. Culprit artery prediction was attempted according to the available algorithms and correlated with the angiogram finding. Results: Out of 89 cases 47 patients had left anterior descending artery (LAD), 27 had right coronary artery (RCA) and 15 had left circumflex artery (LCX) as culprit vessel. All patients with total occlusion of LAD and RCA had ST segment elevation, while only 50% of patients with circumflex artery occlusions had classical ST segment elevation. Conclusion: In our study we found that half of total circumflex artery occlusions were classified as non-ST elevation acute coronary syndrome when using the current 12-lead ECG criteria. This emphasizes the need for the incorporation of routine posterior leads in cases of suspected acute coronary syndrome if classical ST elevation is not present in 12-lead ECG .Otherwise many patients with totally occluded culprit arteries may be denied, the revascularization procedures in their golden hour.