Predicting the culprit artery in acute inferior wall STEMI using ST segment elevation in leads V7-9 and accessing the significance of previously published criteria

In acute inferior ST-segment elevation myocardial infarction (STEMI), multiple electrocardiographic algorithms have been proposed to predict the culprit artery. Our purpose is to review these and compare them to new algorithm using information regarding ST elevation in posterior leads to predict culprit artery in inferior STEMI. 260 consecutive patients with ST-segment elevation in the inferior ECG leads, and coronary arteriography performed within 7 days of the onset of symptoms were retrospectively analysed. The culprit vessel was predicted by the ECG, and findings were correlated with angiography. We then reviewed the algorithms proposed by Fiol et al and Tierala et al, and applied them for predicting the culprit artery, to the population. Finally, we compared the sensitivities and specificities of the respective algorithms for predicting the culprit artery. Sensitivity and specificity of our algorithm to predict RCA as culprit artery were 83% and 93%, respectively, 93% and 83%, respectively for predicting the LCX as the culprit. When we applied the algorithms of Fiol et al and Tierala et al to our study population, they both resulted in slightly lower specificities for RCA prediction and lower sensitivities for LCX prediction as the culprit artery, compared to our algorithm. Routine recording of posterior precordial leads (V7-9) increases the accuracy of predicting infarct related artery in acute inferior wall MI.