PREDICTION OF CULPRIT ARTERY IN ST-SEGMENT ELEVATED INFERIOR WALL MYOCARDIAL INFARCTION BY ST-SEGMENT DEPRESSION IN LEAD aVR- A SINGLE CENTRE STUDY

Dr. Soumen Chakraborty; Dr. Nazir Ahmed; Dr. Md. Moniruzzaman

Volume : VII, Issue : VII, July - 2018

PREDICTION OF CULPRIT ARTERY IN ST-SEGMENT ELEVATED INFERIOR WALL MYOCARDIAL INFARCTION BY ST-SEGMENT DEPRESSION IN LEAD aVR- A SINGLE CENTRE STUDY

Dr. Soumen Chakraborty, Dr. Nazir Ahmed, Dr. Md. Moniruzzaman

Abstract :

Background & Objective:

Various ECG criteria have been suggested to predict the culprit artery in acute inferior MI based on analysis of ST–segment elevation and depression in different leads and importance of ST–segment depression in lead aVR as a sign of LCx occlusion has also been emphasized. The present study was conducted to determine the diagnostic accuracy of ST–segment depression in lead aVR in predicting the culprit artery in ST–elevated inferior myocardial infarction.

Patients & Methods:

This cross–sectional study included a total of 116 patients who presented with ST–segment elevated inferior myocardial infarction and were admitted in CCU (NHFH&RI) and underwent coronary angiogram during hospitalization. The patients were divided into two groups – Cases having ST–segment depression ≥ 1mm in lead aVR and Controls having no ST–segment depression in lead aVR Diagnosis of culprit artery was made by coronary angiogram. All the baseline characteristics and outcome were then compared between the two groups.

Result:

In the present study, 47(40.5%) patients had ST–segment depression ≥ 1 mm in lead aVR and 69(59.5%) patients had no or < 1 mm ST–segment depression in lead aVR. The groups were almost similar in terms of age, sex, BMI, co morbidities/risk factors and duration of chest pain (p > 0.05 in each case). The study demonstrated that ST–segment depression in lead aVR in predicting the LCx as culprit artery in acute inferior myocardial infarction had a sensitivity of 89.8% and a specificity of 95.5% with an overall diagnostic accuracy of 93%.

Conclusion:

So it can be concluded that ST–segment depression of ≥ 1 mm in lead aVR in inferior wall acute myocardial infarction can predict LCx as the culprit artery with fair degree of accuracy.