title: Electrocardiographic determination of culprit lesion site in patients with acute coronary events.
abstract: OBJECTIVE
  The purpose of our study was to determine the ability of electrocardiographic (ECG) criteria derived from prior angiographic-ECG correlative studies to identify life-threatening coronary artery obstructive lesions.
  
  
  METHODS
  We studied 128 consecutive patients referred from the emergency department for emergent coronary angiography for symptoms and ECG changes suggesting an acute coronary event. Using ECG criteria derived from prior studies, we attempted to predict not only the vessel housing the culprit lesion, but whether the lesion was located proximally in that vessel, and then determined the positive and negative predictive values (PPV and NPV) of the criteria used.
  
  
  RESULTS
  Our criteria correctly identified 7 of 11 patients with left main disease, with a PPV of 100% and an NPV of 97%; 12 of 19 patients with proximal left anterior descending coronary artery disease, with a PPV of 67% and an NPV of 94%; and 25 of 28 patients with proximal right coronary artery disease, with a PPV of 64% and an NPV of 97%. The combined PPV and NPV for predicting patients with either left main coronary artery, proximal left anterior descending coronary artery, or proximal right coronary artery disease were 72% and 81%.
  
  
  CONCLUSIONS
  Our study indicates that the location of life-threatening coronary artery lesions in patients presenting with signs and symptoms of acute coronary syndromes can be predicted from the initial ECG with a high degree of accuracy. Recognizing the ECG criteria for such lesions has the potential for shortening door-to-reperfusion time and improving patient outcomes.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of North Carolina Hospitals, Chapel Hill, NC, USA.
authors.forename: Stanley S
authors.initials: SS
authors.lastname: Wang
authors.forename: Lauren
authors.initials: L
authors.lastname: Paynter
authors.forename: Robert V
authors.initials: RV
authors.lastname: Kelly
authors.forename: Gary G
authors.initials: GG
authors.lastname: Koch
authors.forename: Mark S
authors.initials: MS
authors.lastname: Skains
authors.forename: Leonard S
authors.initials: LS
authors.lastname: Gettes
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D054059:Coronary Occlusion / Q000175:diagnosis*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity