The Sensitivity and Specificity of Electrocardiogram in Localizing the Culprit Artery with Angiographic Correlation in Indian Patients with Acute ST-Segment Elevation Myocardial Infarction

Abstract

Background: A detailed analysis of electrocardiogram (ECG) patterns may help in the identification of the precise site and location of coronary artery occlusions and guide the selection of an appropriate clinical therapeutic strategy in patients with myocardial infarction (MI). Aim: This study was conducted to evaluate the sensitivity and specificity of prespecified ECG criteria in localizing the culprit artery in acute ST-segment elevation myocardial infarction (STEMI) and to correlate the ECG findings with coronary angiogram. Methods: Patients with acute STEMI aged ≥l8 years, diagnosed by ECG and who underwent angiography, were included for analysis. The infarct-related artery was identified with prespecified ECG criteria and the measure of agreement kappa was calculated to find the correlation between ECG findings and coronary angiogram. Results: Of 118 patients, anterior wall myocardial infarction (AWMI) was more common than inferior wall myocardial infarction (IWMI) (56% vs. 46%). In AWMI, ST-elevation ≥2.5 mm in V1 and ST-elevation in augmented Vector Left (aVL) had high sensitivity for detecting occlusion proximal to S1 and D1. High correlation with the angiogram was observed with ST-elevation in aVL, V1 for occlusion proximal to S1 and D1 (κ = 0.531; P = 0.000). In IWMI, ST-elevation in lead III > II and ST-elevation ≥1 mm in II, III, augmented Vector Foot (aVF) had maximum sensitivity in detecting occlusion in proximal and distal right coronary artery (RCA). High correlation with the angiogram was observed with ST-elevation in lead III > II (κ = 0.438; P = 0.000) and ST-coving without ST-elevation in RV4 (sensitivity = 79%, κ = 0.402; P = 0.002) for occlusion in the RCA. Ratio of S:R waves amplitude in aVL ≤3 and ST-depression ≥0.5 mm V1-V3 were 100% sensitive for occlusion in the left circumflex (LCx). Strong correlation with the angiogram was observed with ST-elevation ≥0.5 mm V7–V9 for occlusion in LCx (sensitivity = 94%, κ = 0.743; P = 0.000). Conclusion: ECG in patients with STEMI is valuable and can reliably predict the culprit artery in these patients prior to angiography.