Key result
Diagnostic methods using double leads, particularly ST-segment elevation in III > II, accurately identified the culprit artery in inferior wall STEMI with a diagnostic odds ratio of 17 and an AUC of 0.88.
Why the study?
Multiple 12-lead ECG methods and algorithms identify the culprit artery in inferior wall STEMI, but their diagnostic properties remain under-recognized.
Do simple double-lead 12-lead ECG methods accurately identify the culprit artery in patients with inferior wall STEMI compared to complex algorithms?
Meta-Analysis (n=4,414)
Do simple double-lead 12-lead ECG methods accurately identify the culprit artery in patients with inferior wall STEMI compared to complex algorithms?
Simple 12-lead ECG criteria, specifically STE in III > II combined with STD in aVL > I, provide high diagnostic accuracy for identifying the culprit artery in inferior STEMI, outperforming more complex algorithms.
Answers are grounded in this paper and cite their sources.
Supports simple double-lead ECG criteria for culprit artery identification in inferior STEMI; confirms high accuracy and superiority to complex algorithms.
BACKGROUND: Inferior wall ST-segment elevation myocardial infarction (STEMI) is mostly caused by acute occlusion of right coronary artery (RCA) and left circumflex artery (LCX). Several methods and algorithms using 12-lead ECG were developed to localize the lesion in inferior wall STEMI. However, the diagnostic properties of these methods remain under-recognized. AIMS: The aim of this meta-analysis is to compare the diagnostic properties among the methods of identifying culprit artery in inferior wall STEMI using 12-lead ECG. METHODS: We performed a meta-analysis to calculate the pooled sensitive, specificity, area under the curve (AUC) and diagnostic odds ratio (DOR) of each method. RESULTS: Thirty-three studies with 4414 participants were included in the analysis. Methods using double leads had better diagnostic properties, especially ST-segment elevation (STE) in III > II [with pooled sensitivity 0.89 (0.84-0.93), specificity 0.68 (0.57-0.79), DOR 17 (9-32), AUC 0.88 (0.85-0.91)], ST-segment depression (STD) in aVL > I [with pooled sensitivity 0.82 (0.72-0.90), specificity 0.69 (0.48-0.86), DOR 11 (4-29), AUC 0.85 (0.81-0.88)], and STD V3/STE III ≤1.2 [with pooled sensitivity 0.88 (0.78-0.95), specificity 0.59 (0.42-0.75), DOR 12 (5-27), AUC 0.82 (0.78-0.85)]. Diagnostic algorithms, including Jim score[pooled sensitivity 0.70 (0.55-0.85), specificity 0.88 (0.75-0.96)], Fiol's algorithm [pooled sensitivity 0.54 (0.44-0.62), specificity 0.92 (0.88-0.96)] and Tierala's algorithm [pooled sensitivity 0.60 (0.49-0.71), specificity 0.91 (0.86-0.96)], were not superior to these simple methods. CONCLUSIONS: Our meta-analysis indicated that diagnostic methods using double leads had better properties. STE in III > II together with STD in aVL > I may be the most ideal method, for its accuracy and convenience.
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Zhou et al. (2022) conducted a meta-analysis in Inferior wall ST-segment elevation myocardial infarction (STEMI) (n=4,414). 12-lead ECG diagnostic methods (e.g., STE in III > II) vs. Coronary angiography (reference standard) was evaluated on Diagnostic accuracy for identifying culprit artery (DOR 17, 95% CI 9-32). Diagnostic methods using double leads, particularly ST-segment elevation in III > II, accurately identified the culprit artery in inferior wall STEMI with a diagnostic odds ratio of 17 and an AUC of 0.88.
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