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 is undertaken to identify the culprit vessel from ECG in patients with acute ST elevation myocardial infarction and correlate with coronary angiogram.
This study is a prospective study. The study population consisted of 100 patients with STEMI. With inclusion criteria of Adults ≥ 18 years with symptoms of ACS, patients with new myocardial infarction, ST segment elevation of >1mm in Limb leads and >2mm in chest leads and the exclusion criteria includes patients with known history of structural heart disease that could alter ECG interpretation, previous MI patient, patients who have undergone revascularization procedures before ECG recording, individuals who already have a pacemaker.
The development of a reliable protocol for identifying the culprit vessel in ACS based on ECG findings. ILKAY Classification to specifically identify the culprit vessel in cases of lateral wall MI with coronary angiography.
# RCA occlusion:
# LCX (Left circumflex occlusion):
# Occlusion Proximal to S1:
# Occlusion Proximal to D1:
# Occlusion Distal to S1:
#Occlusion distal to D1:
Categorical variables will be presented as number and percentage (%) and continuous variables will be presented as mean ± SD.
Odds ratio with 95% confidence intervals and positive predictive values (PPV), negative predictive value (NPV) will be calculated for selected variables and their significance. A p value of <0.05 was considered statistically significant.
This protocol outlines a systematic approach to identifying the culprit vessel in ACS using ECG data, with defined inclusion and exclusion criteria.
The admission ECG in patients with ST elevation acute myocardial infarction is valuable not only for determining who should and should not receive early reperfusion treatment, but also for providing information regarding the location and extent of acute myocardial injury. By reflecting the pathophysiology of the myocardium during acute ischemia important information to guide management and determine prognosis can be derived from the electrocardiogram. Electrocardiographic markers of proximal coronary artery occlusion identify relatively large myocardial infarctions that benefit most of the early and complete revascularization strategies such as angioplasty. These criteria although are not the substitute of invasive procedure for differentiating the culprit artery in acute myocardial infarction, but provides an economical, reliable and quick method of differentiating infarct related artery in acute myocardial infarction.
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Dr. Niveda R Emergency Medicine Resident Dept of Emergency Medicine Kauvery Hospital, Alwarpet, Chennai
Guide: Dr. Aslesha Sheth Consultant & Clinical Lead Dept of Emergency Medicine Kauvery Hospital, Alwarpet, Chennai
