PMID- 36707129
OWN - NLM
STAT- MEDLINE
DCOM- 20230131
LR  - 20230215
IS  - 2053-3624 (Print)
IS  - 2053-3624 (Electronic)
IS  - 2053-3624 (Linking)
VI  - 10
IP  - 1
DP  - 2023 Jan
TI  - Localising culprit artery in inferior STEMI.
LID - 10.1136/openhrt-2022-002093 [doi]
LID - e002093
AB  - BACKGROUND: ST elevation myocardial infarction (STEMI) represents a cardiac 
      emergency. Time to diagnosis, identification of culprit lesion, and intervention 
      are important. Inferior STEMI represents a dilemma for cardiologists. The 
      territory can be supplied by the right coronary artery (RCA) or the left 
      circumflex coronary artery (LCx). Diagnostic algorithms have been proposed to 
      predict the culprit artery. METHODS: We performed a single-centre retrospective 
      cohort analysis of all patients admitted to our hospital from 2008 to 2020 with a 
      diagnosis of inferior STEMI. We examined the diagnostic 12 lead ECG for 
      quantification of ST elevation in leads II and III and compared this to culprit 
      lesion found on angiography. RESULTS: There were 304 patients identified with 
      STEMI in our database; 105 were found to have an inferior myocardial infarction 
      by ECG criteria. Ninety-nine were included in our study with either RCA or LCx 
      culprit lesions on angiography (82 males, 17 females). The average age of these 
      patients was 64.9 years old. Sensitivity, specificity, positive predictive value 
      and negative predictive value for ST elevation in lead II exceeding lead III 
      predicting LCx culprit lesion was 0.32 (95% CI 0.13 to 0.57), 0.94 (95% CI 0.86 
      to 0.98), 0.55 (95% CI 0.29 to 0.78), 0.85 (95% CI 0.81 to 0.89), respectively. 
      Sensitivity, specificity, positive predictive value and negative predictive value 
      for ST elevation in lead III exceeding lead II predicting RCA culprit lesion was 
      0.94 (95% CI 0.86 to 0.98), 0.32 (95% CI 0.13 to 0.57), 0.85 (95% CI 0.81 to 
      0.89), 0.55 (95% CI 0.29 to 0.78), respectively. CONCLUSIONS: In inferior STEMI, 
      comparison of ST elevation in leads II and III can reliably predict culprit 
      lesion artery and guide intervention. SUBJECT INDEXING: Culprit artery 
      localisation, inferior stemi, ECG.
CI  - (c) Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Farhat-Sabet, Ardalon
AU  - Farhat-Sabet A
AUID- ORCID: 0000-0002-5639-0031
AD  - Cardiology Service, Department of Medicine, Walter Reed National Military Medical 
      Center, Bethesda, Maryland, USA.
FAU - Smith, Alexandra
AU  - Smith A
AUID- ORCID: 0000-0003-0794-8921
AD  - Cardiology Service, Department of Medicine, Brooke Army Medical Center, San 
      Antonio, Texas, USA alexandra.j.smith2.mil@health.mil.
FAU - Atwood, John E
AU  - Atwood JE
AD  - Cardiology Service, Department of Medicine, Walter Reed National Military Medical 
      Center, Bethesda, Maryland, USA.
FAU - Pickett, Christopher
AU  - Pickett C
AD  - Cardiology Service, Department of Medicine, Brooke Army Medical Center, San 
      Antonio, Texas, USA.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Open Heart
JT  - Open heart
JID - 101631219
SB  - IM
MH  - Male
MH  - Female
MH  - Humans
MH  - Middle Aged
MH  - Aged
MH  - *ST Elevation Myocardial Infarction/diagnostic imaging
MH  - Retrospective Studies
MH  - Sensitivity and Specificity
MH  - Coronary Angiography
MH  - Coronary Vessels/diagnostic imaging
MH  - Arrhythmias, Cardiac
PMC - PMC9884921
OTO - NOTNLM
OT  - Acute Coronary Syndrome
OT  - Chest Pain
OT  - Coronary Vessels
OT  - Myocardial Infarction
COIS- Competing interests: The view(s) expressed here are those of the author(s) and do 
      not reflect the official policy or position of Brooke Army Medical Center, Walter 
      Reed National Military Medical Center, the US Army Medical Department, the US 
      Army Office of the Surgeon General, the Department of the Army, or the Department 
      of Defense or the US government.
EDAT- 2023/01/28 06:00
MHDA- 2023/02/01 06:00
PMCR- 2023/01/26
CRDT- 2023/01/27 20:53
PHST- 2022/07/20 00:00 [received]
PHST- 2022/10/13 00:00 [accepted]
PHST- 2023/01/27 20:53 [entrez]
PHST- 2023/01/28 06:00 [pubmed]
PHST- 2023/02/01 06:00 [medline]
PHST- 2023/01/26 00:00 [pmc-release]
AID - openhrt-2022-002093 [pii]
AID - 10.1136/openhrt-2022-002093 [doi]
PST - ppublish
SO  - Open Heart. 2023 Jan;10(1):e002093. doi: 10.1136/openhrt-2022-002093.