title: New electrocardiographic criteria for predicting the site of coronary artery occlusion in inferior wall acute myocardial infarction.
abstract: In patients with inferior wall acute myocardial infarction (AMI), the site of the culprit lesion is an important determinant of outcome. Patients with right ventricular infarction have a poor prognosis, whereas those with occlusion of the left circumflex coronary artery (LCx) have a good prognosis. Therefore, we assessed whether standard 12-lead electrocardiograms obtained on admission could identify the site of coronary artery occlusion, (i.e., a site proximal to the origin of the right ventricular branch of the right coronary artery [RCA], a site distal to the origin of the right ventricular branch of the RCA, or a site in the LCx). The ratio of ST depression in lead V3 to ST elevation in lead III (V3/III ratio) was evaluated immediately before coronary angiography in 152 patients with a first inferior wall AMI confirmed by coronary angiography within 12 hours after the onset of symptoms. For occlusion of the proximal RCA, distal RCA, and LCx, V3/III ratio was 0.2+/-0.3, 0.8+/-0.5, and 2.5+/-2.5 (p = 0.0001), respectively. The V3/III ratio <0.5 identified proximal RCA occlusion, 0.5 <V3/III ratio < or = 1.2 identified distal RCA occlusion, and 1.2 <V3/III ratio identified LCx occlusion with sensitivities of 91%, 84%, and 84%, and specificities of 91%, 93%, and 95%, respectively. We conclude that the V3/III ratio is useful in predicting the site of coronary artery occlusion in patients with inferior wall AMI.
authors.affiliation: Critical Care and Emergency Medical Center, and the Second Department of Internal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kosuge
authors.forename: K
authors.initials: K
authors.lastname: Kimura
authors.forename: T
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Y
authors.initials: Y
authors.lastname: Hongo
authors.forename: Y
authors.initials: Y
authors.lastname: Mochida
authors.forename: M
authors.initials: M
authors.lastname: Sugiyama
authors.forename: O
authors.initials: O
authors.lastname: Tochikubo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity