Predicting the infarct-related artery in STEMI from the surface ECG: Independent validation of proposed criteria

Rob Eerdekens, Jose F. Chavez, Justin M. Fox, James D. Flaherty, Lukas R.C. Dekker, Nils P. Johnson*

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Aims: This study independently evaluated the diagnostic performance of electrocardiographic (ECG) criteria to predict the infarct-related artery (IRA) in patients with an acute ST-segment elevation myocardial infarction (STEMI). While a number of ECG criteria have been proposed to predict the IRA in STEMI, many of these "rules" came from modestly sized populations and did not undergo external validation. Therefore, we aimed to evaluate popular criteria from the literature in an independent cohort. Methods and results: All acute STEMI cases over a 10-year period from a single hospital were retrospectively identified. We excluded patients with a missing pre-intervention ECG, irretrievable angiographic films, prior coronary artery bypass grafting, left bundle branch block, ventricular pacing, or not meeting strict STEMI criteria. After review of the angiograms for the IRA, cases with either no or multiple culprits were excluded. We included 480 subjects meeting STEMI criteria in inferior leads (192, 40%), anterior leads (184, 38%), both anterior and inferior leads (88, 18%), isolated lateral leads (nine, 2%), or a posterior pattern (seven, 1%). Notably, every pattern except isolated lateral STEMI included an IRA in both the right and left coronary arteries. Conclusions: Existing ECG criteria to predict the IRA in STEMI have modest diagnostic performance when externally validated, and lower than in the original reports. Distinguishing the level of obstruction in the left anterior descending artery remains especially challenging. Hence, their use should be pragmatic when selecting an initial catheter for treating STEMI, since discordances will occur when compared to the actual angiogram.

Original languageEnglish (US)
Pages (from-to)953-961
Number of pages9
JournalEuroIntervention
Volume13
Issue number8
DOIs
StatePublished - Oct 2017

    Fingerprint

Keywords

  • Other technique
  • Plaque rupture
  • ST-elevation myocardial infarction (STEMI)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this