A comprehensive and easy-to-use ECG algorithm to predict the coronary occlusion site in ST-segment elevation myocardial infarction - 08/12/22

Doi : 10.1016/j.ahj.2022.10.077

Carlo Gaspardone, MD ^a,^{^{⁎
Carlo Gaspardone, MD and Davide Romagnolo, MD equally contributed to the article and should be considered as shared first authors.}}, Davide Romagnolo, MD ^a,^{^{⁎
Carlo Gaspardone, MD and Davide Romagnolo, MD equally contributed to the article and should be considered as shared first authors.}}, Alessandro Fasolino, MD ^b, Giulio Falasconi, MD ^a, Alessandro Beneduce, MD ^c, Giorgio Fiore, MD ^a, Emma Didelon, MSc ^a, Fabrizio Fortunato, MD ^d, Carmine Galdieri, MD ^a, Giuseppe Antonio Posteraro, MD ^e, Giacomo Ingallina, MD ^f, Francesco Ancona, MD ^f, Federico Biondi, MD ^f, Silvana Di Maio, MD ^a, Alice Casiraghi, MD ^a, Massimo Slavich, MD ^g, Giorgia Borio, MD ^a, Simone Savastano, MD ^h, Sergio Leonardi, MD ^b, Alberto Margonato, MD ^a,^g, Eustachio Agricola, MD ^a,^f, Michele Oppizzi, MD ^g, Achille Gaspardone, MD, MPhil ^e, Carlo Pappone, MD, PhD ^a,ⁱ, Matteo Montorfano, MD ^a,^c,^⁎
^a Vita-Salute San Raffaele University, Milan, Italy.
^b Department of Molecular Medicine, University of Pavia, Pavia, Italy.
^c Unit of Interventional Cardiology, IRCCS San Raffaele, Milan, Italy.
^d Division of Cardiology, Paolo Giaccone Hospital, Palermo, Italy.
^e Division of Cardiology, S. Eugenio Hospital, Rome, Italy.
^f Unit of Cardiovascular Imaging, IRCCS San Raffaele, Milan, Italy.
^g Unit of Clinical Cardiology, IRCCS San Raffaele, Milan, Italy.
^h Division of Cardiology, IRCCS San Matteo, Pavia, Italy.
ⁱ Department of Arrhythmology, IRCCS San Donato, Milan, Italy.

^⁎⁎Reprint requests; Matteo Montorfano, MD, Unit of Interventional Cardiology, IRCCS San Raffaele, Via Olgettina 60, 20132 Milan, Italy.Interventional CardiologySan Raffaele Scientific InstituteVia Olgettina, 60Milan20132Italy

Abstract

Background

Several electrocardiogram (ECG) criteria have been proposed to predict the location of the culprit occlusion in specific subsets of patients presenting with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to develop, through an independent validation of currently available criteria, a comprehensive and easy-to-use ECG algorithm, and to test its diagnostic performance in real-world clinical practice.

Methods

We analyzed ECG and angiographic data from 419 consecutive STEMI patients submitted to primary percutaneous coronary intervention over a one-year period, dividing the overall population into derivation (314 patients) and validation (105 patients) cohorts. In the derivation cohort, we tested >60 previously published ECG criteria, using the decision-tree analysis to develop the algorithm that would best predict the infarct-related artery (IRA) and its occlusion level. We further assessed the new algorithm diagnostic performance in the validation cohort.

Results

In the derivation cohort, the algorithm correctly predicted the IRA in 88% of cases and both the IRA and its occlusion level (proximal vs mid-distal) in 71% of cases. When applied to the validation cohort, the algorithm resulted in 88% and 67% diagnostic accuracies, respectively. In a real-world comparative test, the algorithm performed significantly better than expert physicians in identifying the site of the culprit occlusion (P = .026 vs best cardiologist and P < .001 vs best emergency medicine doctor).

Conclusions

Derived from an extensive literature review, this comprehensive and easy-to-use ECG algorithm can accurately predict the IRA and its occlusion level in all-comers STEMI patients.

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Graphical abstract

Image, graphical abstract

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Keywords : Electrocardiogram, ECG, Myocardial infarction, STEMI, Infarct related artery, Culprit artery, Algorithm

Abbreviations : AUC, CABG, CI, CTO, D1, IRA, LAD, LBBB, LCX, LV, NPV, OM1, OR, PCI, PPV, RBBB, RCA, ROC, RV, S1, Se, Sp, STD, STE, STEMI

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Vol 255

P. 94-105 - janvier 2023 Retour au numéro

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A comprehensive and easy-to-use ECG algorithm to predict the coronary occlusion site in ST-segment elevation myocardial infarction - 08/12/22

Abstract

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