Open AccessDiagnostic flowchart to estimate the morphology of left descending artery lesions by initial electrocardiogram in ST‐elevation myocardial infarction
Author(s) -
Fujii Toshiharu,
Hasegawa Misaki,
Nakamura Norihito,
Ikari Yuji
Publication year - 2020
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/anec.12695
Subject(s) - medicine , cardiology , st segment , myocardial infarction , culprit , electrocardiography , st elevation , st depression , artery , right coronary artery , coronary angiography
Background ST‐segment deviations in an initial 12‐lead electrocardiogram provide anatomical information in ST‐elevation myocardial infarction (STEMI). A diagnostic flowchart was formulated to estimate the anatomical characteristics of a culprit left anterior descending artery (LAD). Methods The present study analyzed 252 STEMI patients whose culprit lesions were confirmed to be LAD as an observational study. LAD morphology, wrapped ( n = 26) or not ( n = 226), and the positional relationship to first diagonal branch ( n = 162 in proximal, n = 90 in distal lesions) were assessed. Their ST‐segment deviations and such anatomical characteristics were examined. Results Reciprocal ST depression in nonwrapped LAD was frequent in patients without diagonal branch flow (49.3%–18.8% in II, p < .01; 66.4%–36.3% in III, p < .01; 63.7%–30.0% in aVF, p < .01). ST elevation in inferior leads was the characteristics of wrapped LAD but was not the case in patients without diagonal flow (50%–0% in II, 60%–0% in III, and 60%–0% in aVF). ST elevation in lateral leads to the diagonal branch in nonwrapped LAD is more frequent for proximal than distal lesions (36.3% vs. 15.0% in I, p < .01; 50.7% vs. 16.3% in aVL, p < .01), but this was not observed for wrapped LAD (18.8% vs. 20.0% in I, p = .72; 31.3% vs. 10.0% in aVL, p = .21). Positive and negative predictive values for the diagnostic accuracy of suggested diagnostic flow based on the above results were 0.794 and 0.478, respectively. Conclusions Our suggested diagnostic flowchart provides enough diagnostic accuracy to estimate culprit morphology.