Electrocardiographic determination of culprit lesion site in patients with acute coronary events

Abstract

Purpose: The purpose of our study was to determine the ability of electrocardiographic (ECG) criteria derived from prior angiographic-ECG correlative studies to identify life-threatening coronary artery obstructive lesions.

Methods: We studied 128 consecutive patients referred from the emergency department for emergent coronary angiography for symptoms and ECG changes suggesting an acute coronary event. Using ECG criteria derived from prior studies, we attempted to predict not only the vessel housing the culprit lesion, but whether the lesion was located proximally in that vessel, and then determined the positive and negative predictive values (PPV and NPV) of the criteria used.

Results: Our criteria correctly identified 7 of 11 patients with left main disease, with a PPV of 100% and an NPV of 97%; 12 of 19 patients with proximal left anterior descending coronary artery disease, with a PPV of 67% and an NPV of 94%; and 25 of 28 patients with proximal right coronary artery disease, with a PPV of 64% and an NPV of 97%. The combined PPV and NPV for predicting patients with either left main coronary artery, proximal left anterior descending coronary artery, or proximal right coronary artery disease were 72% and 81%.

Conclusion: Our study indicates that the location of life-threatening coronary artery lesions in patients presenting with signs and symptoms of acute coronary syndromes can be predicted from the initial ECG with a high degree of accuracy. Recognizing the ECG criteria for such lesions has the potential for shortening door-to-reperfusion time and improving patient outcomes.