Heart India (Jan 2019)
Correlation between the diagnostic accuracy of the electrocardiogram and coronary angiography in localization of occluded artery in acute ST-elevation myocardial infarction: A single-center experience
Abstract
Background: The electrocardiogram (ECG) remains the crucial tool in the diagnosis of acute ST-elevation myocardial infarction (STEMI) other than coronary angiography (CAG). However, the specificity of the ECG in culprit vessel localization is limited due to the individual variations in coronary anatomy as well as by the presence of preexisting coronary artery disease. The current observational study was designed to establish the correlation between the diagnostic accuracy of ECG with CAG to predict the culprit artery in STEMI. Materials and Methods: A total of 140 consecutive STEMI (ST elevation of >2 mm in at least 2 contiguous leads) patients were enrolled over 1.5 years at a tertiary care center in India. Based on ECG criteria, evaluated by blinded observer, patients were categorized into anterior, inferior with or without right ventricular infarction, and posterior wall myocardial infarction. Each group was further divided based on the culprit artery. Results: A total of 96 (68.6%) were males and 109 (77.9%) were 51–70 years. ECG showed perfect agreement (κ = 0.895, 0.882, and 0.853, respectively) with CAG in the diagnosis of proximal left anterior descending (LAD), proximal right coronary artery (RCA), and mid and distal RCA. It showed just fair agreement (κ = 0.348) with CAG in the diagnosis of distal LAD. Moreover, ECG showed perfect agreement (κ = 1) with CAG in the identification of both LAD proximal to D1 and distal to S1 and left circumflex artery. Conclusion: In STEMI patients, the diagnostic accuracy of ECG exhibits good correlation and agreement with CAG to predict the culprit vessels except for distal LAD.
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