Prediction of the infarct-related artery in acute myocardial infarction by a scoring system using summary ST-segment and T-wave changes.
We developed a scoring system to predict the artery responsible for an acute myocardial infarction (AMI) using ST-segment and T-wave changes on the initial electrocardiogram (ECG) using data from 228 patients (development set) with symptoms compatible with AMI and tested in a similar group of 223 patients (test set) from the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI-5) Trial. Using stepwise logistic regression we were able to accurately predict the left anterior descending (LAD), right, or left circumflex (LC) coronary artery as the infarct-related artery using 2 variables: (1) the summation of the ST-segment elevation in leads V1 to V4; and (2) the summation of the T-wave negativity in leads I, aVL, and V5. In the development set, these 2 variables demonstrated respective sensitivity and specificity of 98% and 90% for LAD lesions, 82% and 85% for right narrowings, and 82% and 84% for LC narrowings. In the test set, the sensitivity and specificity were 97% and 95% for LAD lesions, 85% and 86% for right lesions, and 73% and 60% for LC coronary artery lesions. Information easily obtained on the ECG can accurately predict the likelihood of the LAD, right, or LC artery as the infarct-related artery. This may be useful in the decision to administer thrombolytic treatment.
Midgette
A S
AS
Department of Medicine, New England Medical Center, Boston, Massachusetts, USA.
Griffith
J L
JL
Califf
R M
RM
Laks
M M
MM
Dietz
S B
SB
Beshansky
J R
JR
Selker
H P
HP
D003327:Coronary Disease / Q000175:diagnosis / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D004562:Electrocardiography / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005544:Forecasting; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy / Q000473:pathology*; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015912:Thrombolytic Therapy; D016896:Treatment Outcome