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ORIGINAL ARTICLE
Year : 2017  |  Volume : 6  |  Issue : 4  |  Page : 128-132

Role of electrocardiogram in identification of culprit vessel occlusion in acute ST elevation myocardial infarction in relation to coronary angiography


Department of Medicine, Dr. D.Y. Patil Medical College, D.Y. Patil University, Kolhapur, Maharashtra, India

Correspondence Address:
Rajesh J Khyalappa
Department of Medicine, Dr. D.Y. Patil Medical College, D.Y. Patil University, Kolhapur, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCPC.JCPC_11_17

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Objective: The objective of the study is to study the usefulness of electrocardiography in localizing the culprit vessel in acute ST-elevation myocardial infarction (STEMI) and to assess the diagnostic accuracy of the electrocardiogram (ECG) findings by comparing them with coronary angiographic findings. Materials and Methods: This study is prospective observational study, conducted on fifty patients in tertiary care center attached to medical college. Patients with ST-segment elevation in ECG was evaluated to identify culprit vessel and later correlated with their coronary angiography. Results: Among fifty patients in the study, 34 had anterior wall, and 16 had inferior wall myocardial infarction. ST↑ >1 mm in V4R, ST↓V3/ST↑LIII <0.5 were equally sensitive for diagnosing proximal right coronary artery occlusion. For left circumflex occlusion, ST elevation in lead III >lead II was the most sensitive and ratio of ST↓V3/ST↑LIII >1.2 was the most specific criterion. In anterior wall STEMI, 52.9% patients had occlusion proximal to first septal (S1), 17.6% had occlusion proximal to first diagonal (D1), 8.8% had occlusion distal to S1, and 20.5% had occlusion distal to D1. Q wave in aVL had maximum sensitivity for identifying occlusion proximal to D1 and Q wave in leads V4-V6 for occlusion distal to S1. Conclusion: The admission ECG in patients with STEMI is valuable not only for determining early reperfusion treatment, but also provides important information to guide clinical decision-making.


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