Implications of the absence of st-segment elevation in lead V4Rin patients who have inferior wall acute myocardial infarction with right ventricular involvement

ST-segment elevation (ST ↑) ≥1.0 mm in lead V4R is considered a reliable marker of right ventricular involvement (RVI) in inferior acute myocardial infarction (IMI). However, the impact of posterior involvement (PI) on the relation between RVI and ST ↑ in lead V4R is unknown. We studied 267 patients with a first IMI who had total occlusion and TIMI 3 flow of the right coronary artery within 6 h after the onset. A 12-lead ECG, lead V4R, and leads V7–9 were recorded on admission. RVI was defined as occlusion proximal to the first right ventricular branch. The perfusion territory was assessed by angiographic distribution score, and PI was defined as a score of ≥0.7. Myocardial blush grade was assessed immediately after reperfusion. Patients were stratified according to the presense or absense of PI and RVI. Times to admission and reperfusion were similar in the 4 groups. RVI was associated with higher peak creatine kinase and higher rates of impaired myocardial reperfusion (blush grade 0/1) and congestive heart failure during hospitalization in the presense or absense of PI, especially the former. RVI was associated with a higher rate of ST ↑ in lead V4R in the absence, but not in the presence, of PI. ST ↑ in lead V4R identified RVI with sensitivities of 34% and 96% (p<0.001) and specificities of 83% and 82% (NS) in the presence and absence of PI, respectively. In patients with reperfused IMI, RVI is associated with a larger infarct size and impaired myocardial reperfusion. However, the incidence of RVI diagnosed by ST ↑ in lead V4R was underestimated in the presence of posterior involvement. ST ↑ in lead V4R caused by RVI might be attenuated due to a reciprocal change in posterior ST ↑.

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Abstract 9408: ST-Segment Elevation in Leads V5-6 Predicts In-Hospital Adverse Outcomes in Patients With Reperfused Inferior Acute Myocardial Infarction

Circulation ◽

10.1161/circ.130.suppl_2.9408 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Masami Kosuge ◽

Toshiaki Ebina ◽

Kiyoshi Hibi ◽

Kengo Tsukahara ◽

Noriaki Iwahashi ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Adverse Events ◽

Reperfusion Therapy ◽

Adverse Outcomes ◽

Prognostic Impact ◽

Inferior Wall ◽

St Segment Elevation ◽

Left Circumflex Artery ◽

St Segment

Introduction: In inferior wall acute myocardial infarction (IWMI), ST-segment elevation in leads V5-6 (STE V5-6) is often observed, but its prognostic impact is unclear. Methods: We examined admission ECGs in 361 patients with a first IWMI who had TIMI 3 flow of the right coronary artery (RCA) or left circumflex artery (LCX) by reperfusion therapy within 6 hours after symptom onset. Patients were divided according to the presence (n=77) or absence (n=284) of STE V5-6 >2 mm, and the former was subdivided into the 2 groups according to the degree of STE in leads III and V6: STE:III>V6 (n=53) and STE:III≤V6 (n=24). The perfusion territory of the culprit artery was assessed by angiographic distribution score, and mega-artery was defined as a score ≥0.7. Results: Age, sex, time to admission, reperfusion therapy, or time to reperfusion was similar in the 3 groups. STE V5-6 was associated with mega-artery occlusion, larger infarction, and in-hospital adverse events (death, reinfarction, or heart failure). RCA occlusion was most common in STE V5-6 with STE:III>V6, whereas LCX occlusion, especially proximal LCX occlusion, was most common in STE V5-6 with STE:III≤V6. In multivariate analysis, STE V5-6 with STE:III>V6 (OR 2.90, 95%CI 1.10-7.02, p<0.01) and that with STE:III≤V6 (OR 3.63, 95%CI 1.58-8.96, p<0.01) were independent predictors of in-hospital adverse events. Conclusions: In reperfused IWMI, ST-segment elevation in leads V5-6 on admission ECG strongly predicts in-hospital adverse outcomes; furthermore, comparing the degree of ST-segment elevation in leads III and V6 is useful for predicting the culprit artery (i.e., RCA or LCX).

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Posterior wall involvement attenuates predictive value of ST-segment elevation in lead V4R for right ventricular involvement in inferior acute myocardial infarction

Journal of Cardiology ◽

10.1016/j.jjcc.2009.06.006 ◽

2009 ◽

Vol 54 (3) ◽

pp. 386-393 ◽

Cited By ~ 8

Author(s):

Masami Kosuge ◽

Toshiyuki Ishikawa ◽

Satoshi Morita ◽

Toshiaki Ebina ◽

Kiyoshi Hibi ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Right Ventricular ◽

Predictive Value ◽

Posterior Wall ◽

St Segment Elevation ◽

St Segment ◽

Inferior Acute Myocardial Infarction

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Acute myocardial infarction with ST segment elevation in inferior and anterior leads: right ventricular infarction

BMJ Case Reports ◽

10.1136/bcr.03.2009.1700 ◽

2010 ◽

Vol 2010 (feb02 1) ◽

pp. bcr0320091700-bcr0320091700

Author(s):

R. Berent ◽

J. Auer ◽

S. von Duvillard ◽

H. Sinzinger ◽

D. Steinbrenner ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Right Ventricular ◽

St Segment Elevation ◽

Right Ventricular Infarction ◽

St Segment ◽

Ventricular Infarction

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Role of electrocardiogram in identifying the infarct related artery in acute myocardial infarction and to correlate it with 2D echo and coronary angiogram

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20200657 ◽

2020 ◽

Vol 7 (3) ◽

pp. 451

Author(s):

Jacob Abraham Ruram ◽

Rami Reddy Ganta ◽

P. Arunachalam

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Artery Occlusion ◽

Inferior Wall ◽

St Segment Elevation ◽

St Segment ◽

Infarct Related Artery ◽

St Elevation ◽

Sensitivity Specificity

Background: The Electrocardiogram remains a crucial tool in the identification and management of acute myocardial infarction. A detailed analysis of patterns of ST segment elevation may influence decisions regarding the perfusion therapy. This study was undertaken to study the role of ECG in identifying the infarct related artery in acute ST elevation MI and to correlate its findings with 2 D ECHO and Coronary angiogram.Methods: A total of 100 patients who presented with acute ST elevation MI were randomly selected for the study. After admission all the patients underwent ECG, CPK, CK-MB levels, 2D ECHO and CAG. Patients with ST segment elevation from ECG was evaluated to identify culprit vessel and the ECG findings were then correlated with 2D ECHO and CAG to identify the Sensitivity, Specificity, Positive predictive value and Negative predictive value of ECG in identifying the infarct related artery.Results: Fifty-two (52%) patients had an Anterior wall MI, forty-two patients (42%) had an evidence of Inferior wall MI and Six patients (6%) were found to have Antero inferior wall MI in the study group. Thirty-eight (38%) had evidence of SVD, forty-six patients (46%) had DVD and Sixteen patients (16%) had TVD. Sensitivity, Specificity, PPV and NPV of the ECG in identifying the LAD artery occlusion were 60.5%, 100%, 100% and 44.4% respectively. Sensitivity, Specificity, PPV and NPV of ECG in identifying the RCA artery occlusion were 78.5%, 100%, 100% and 78.5% respectively. Sensitivity, Specificity, PPV and NPV of the ECG in identifying the LCx artery occlusion were 26%, 96%, 86% and 60% respectively.Conclusions: ECG was found to be a sensitive and specific tool in identifying the infarct related Coronary artery in acute ST elevation MI.

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