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. 2004 Oct;9(4):383-8.
doi: 10.1111/j.1542-474X.2004.94585.x.

New criteria based on ST changes in 12-lead surface ECG to detect proximal versus distal right coronary artery occlusion in a case of acute inferoposterior myocardial infarction

Miquel Fiol  1 , Andrés Carrillo, Iwona Cygankiewicz, José Ayestarán, Onofre Caldés, Vicente Peral, Armando Bethencourt, Wojciech Zareba, Antoni Bayés de Luna
Affiliations

New criteria based on ST changes in 12-lead surface ECG to detect proximal versus distal right coronary artery occlusion in a case of acute inferoposterior myocardial infarction

Miquel Fiol et al. Ann Noninvasive Electrocardiol. 2004 Oct.

Abstract

Background: The outcome of patients with inferoposterior myocardial infarction (MI) due to occlusion of right coronary artery (RCA) depends mainly on the location of occlusion (distal vs. proximal). The aim of this study was to evaluate the value of new ECG criteria: the sum of ST depression in I and VL leads and ST changes in V1 lead to predict the location of RCA occlusion in the case of an inferoposterior MI.

Methods: The ECG and angiographical findings of 50 patients with acute inferoposterior MI due to RCA occlusion were analyzed. The value of new criteria was studied alone and in combination to predict proximal versus distal RCA occlusion and compared with previously described criterion based only on ST changes in VL.

Results: Isoelectric or elevated ST in V1 allowed predicting proximal RCA occlusion with 70% sensitivity and 87% specificity with high positive and negative predictive value (87% and 71%, respectively). The new criterion of the sum of ST depression in I and VL >or= 5.5 mm compared to the criterion based only on ST depression in VL was also more specific (91% vs. 72%) for proximal RCA occlusion with better positive and negative predictive values.

Conclusions: The new criterion based on the ST changes in V1 lead is highly accurate in detecting the location of occlusion in the RCA compared to the criteria based only on ST changes in lateral leads. The use of this criterion might increase the accuracy of ECG-based identification of myocardial involvement in acute inferoposterior MI.

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Figures

Figure 1
Figure 1
Examples of ECG tracings in patients with an acute inferoposterior myocardial infarction due to (A) proximal or (B) distal RCA occlusion. Note the differences of ST segment in V1 lead with similar behavior of ST segment in I and VL leads.
Figure 2
Figure 2
The values of sensitivity (SE), specificity (SP), negative (NPV), and positive predictive values (PPV) for different ECG criteria to predict (A) proximal and (B) distal RCA occlusion.
Figure 3
Figure 3
Injury vectors in case of an evolving inferior myocardial infarction (A) with or (B) without right ventricle involvement .
See this image and copyright information in PMC

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