Key result
ST segment depression in leads aVR and aVL identified RCA occlusion with 98% sensitivity and 82% specificity, and LCX occlusion with 83% sensitivity and 98% specificity.
Why the study?
Does ST segment depression in leads aVR and aVL predict the infarct-related artery in patients with acute inferior wall myocardial infarction?
Observational (n=159)
Does ST segment depression in leads aVR and aVL predict the infarct-related artery in patients with acute inferior wall myocardial infarction?
In patients with acute inferior wall myocardial infarction, comparing ST segment depression in leads aVR and aVL provides a highly sensitive and specific method for identifying the culprit artery prior to angiography.
Answers are grounded in this paper and cite their sources.
May aid pre-angiographic culprit artery localization in inferior MI; hypothesis-generating and requires prospective validation.
Objectives: The aim of the study was to assess the role of ST segment depression in the limb leads aVR and aVL for the diagnosis of acute posterior wall infarction and the identification of infarct related artery (IRA) in patients with acute inferior wall MI. Methods: In 159 patients with I-STEMI, 127 (80%) had RCA occlusion and 32 (20%) had LCX occlusion. In the ECG algorithms, RCA occlusion was indicated by ST depression in lead aVL higher than lead aVR and no ST depression in lead aVL and aVR. LCX occlusion was indicated by ST depression in lead aVR higher than or equal to lead aVL and no ST depression in aVL and aVR. Results: The sensitivity, specificity, positive and negative predictive values of these algorithms were high (98%, 82%, 92% and 95% for RCA occlusion and 83%, 98%, 95% and 92% for LCX occlusion). Conclusion: The ECG algorithms can reliably identify the culprit artery in I-STEMI. ST segment depression in limb leads aVR and aVL with avR ≥ aVL helps to diagnose left circumflex artery as a culprit IRA in an acute inferior wall MI.
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Sahi et al. (2015) conducted an observational in Acute inferior wall myocardial infarction (n=159). ST segment depression in limb leads aVR and aVL was evaluated on Identification of infarct related artery (RCA or LCX occlusion). ST segment depression in leads aVR and aVL identified RCA occlusion with 98% sensitivity and 82% specificity, and LCX occlusion with 83% sensitivity and 98% specificity.
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