Why the study?
Does the combination of ST depression in lead I and ST elevation in V1 accurately predict proximal right coronary artery occlusion in patients with acute coronary syndrome?
Does the combination of ST depression in lead I and ST elevation in V1 accurately predict proximal right coronary artery occlusion in patients with acute coronary syndrome?
ST changes in leads V1 and I on a standard 12-lead ECG can accurately predict proximal right coronary artery occlusion, aiding in the early screening for right ventricular infarction.
May aid ECG screening for proximal RCA occlusion in ACS; leaves open prospective validation before clinical adoption.
BACKGROUND/AIMS: Prediction of lesions of the proximal right coronary artery (pRCA) through electrocardiogram (ECG) is very important because pRCA occlusion has many complications and a high mortality rate, which has frequently been related with right ventricular infarction. The purpose of this study was to devise a screening tool that takes into account multiple leads from a 12-lead ECG to predict the pRCA lesion. METHODS: A hundred and fifty-eight patients who were diagnosed as acute coronary syndrome and had a pure lesion of RCA or left circumf lex artery (LCX) by ECGs and angiographic findings were enrolled retrospectively. Forty-eight patients with a pure pRCA occlusion were compared to a control group of 110 patients who were diagnosed as having either a pure mid to distal RCA lesion (57 patients) or a pure LCX lesion (53 patients). The combination of ST depression (≤ 0 mm) in I and ST elevation (> 0.5 mm) in V1 was the best diagnostic tool (area under the curve, 0.84). CONCLUSIONS: ST changes in leads V1 and I allow more accurate prediction of pRCA occlusion than other criteria, such as the difference between ST elevation of leads II and III or vector direction and amplitude. These variables could help to screen for right ventricular infarction before performing reverse ECG and predicting prognosis.
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Koh et al. (2017) studied this question.
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