Factors associated with failure to identify the culprit artery by the electrocardiogram in inferior ST-elevation myocardial infarction |
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Authors: | Tahvanainen Minna Nikus Kjell C Holmvang Lene Clemmensen Peter Sclarovsky Samuel Birnbaum Yochai Kelbæk Henning Huhtala Heini Tilsted Hans-Henrik Eskola Markku J |
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Institution: | a Department of Cardiology, Heart Center, Tampere University Hospital, Tampere, Finlandb Department of Cardiology B, Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmarkc Tele Aviv University, Tel Aviv, Israeld Baylor College of Medicine, Houston, TX, USAe School of Public Health, University of Tampere, Tampere, Finlandf Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark |
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Abstract: | BackgroundRight and left circumflex coronary artery occlusions cause inferior myocardial infarction. To improve the targeting of diagnostic and therapeutic measures individually, factors interfering with identification of the culprit artery by the electrocardiogram (ECG) were explored.MethodsPatients with inferior preinfarction syndrome (n = 266) were included to the Danish Trial in Acute Myocardial Infarction-2 substudy. The culprit vessel was predicted by the ECG, and findings were correlated with angiography. Factors associated with false identification of the culprit artery by the ECG were examined.ResultsElectrocardiogram criteria for right coronary artery occlusion to predict coronary angiography findings had sensitivity, specificity, and positive and negative predictive values of 95%, 52%, 84%, and 81%. For left circumflex coronary artery occlusion, the corresponding values were 51%, 93%, 70%, and 85%, respectively. False ECG identification of the culprit artery was independently associated with left coronary dominance (P < .001; odds ratio OR], 22.0; 95% confidence interval CI], 7.2-67.0), multivessel disease (P = .035; OR, 2.2; 95% CI, 1.1-4.7), and absence of proximal occlusion pattern in the ECG (P = .003; OR, 4.0; 95% CI, 1.6-9.8).ConclusionsLeft coronary artery dominance, multivessel disease, and absence of ECG signs of proximal culprit lesion are associated with failure to predict the culprit artery of inferior myocardial infarction by the 12-lead ECG. |
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Keywords: | Electrocardiogram Infarct related artery ST-elevation myocardial infarction |
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