Session PB1.4

Reliability of the Prediction of the Location of the Culprit Lesion from the ECG in Totally Occluded Arteries in Case of Single Vessel Disease

WA Dijk*, NHJJ van der Putten, R Hoekema, ET van der Velde,
AC Maan, CA Swenne, WRM Dassen

University Medical Center
Groningen, Netherlands

The treatment of ST-elevated myocardial infarction caused by a 100% stenosis in one or more of the coronary arteries is aided by determining the localization of the stenosis on basis of the recorded ECG. Numerous articles have been published concerning this topic. We decided to evaluate the diagnoses of 4 commercially available ECG analysis programs: Muse (General Electric), Escribe (Mortara), Tracemaster (Philips), Megacare (Siemens) and 2 recently proposed algorithms (1, 2). A database was filled with 500 well documented randomly chosen PCI procedures with information on single vessel interventions with TIMI flow equal 0 and a digitally available standard ECG recording within a timeframe of maximal 2 hours previous to the first balloon inflation. The coronary artery anatomy was denoted according to the American Heart Association’s 16-segment description. The area of the myocardium that is perfused by these arteries is determined according to the consensus reached by the North American Societies of Imaging. E.g. the RCA perfuses (in addition to the right ventricle) parts of the inferior region of the septum (segment 3 and 9). The RCA was involved in 41% of the cases, the LAD in 37% and the CX in 21%. The study showed that the commercially available analysis programs perform fairly well (17% false positive, 0% false negative) in determining the infarcted areas linked to the LAD as occluded coronary artery, but generated (not surprisingly) a wide variety of possibilities when the circumflex and RCA are occluded as is the case with inferior and lateral infarctions. Preliminary results of the evaluation of the 2 algorithms, specifically designed to predict the culprit artery directly, show a significantly better determination of the occluded vessel.
1. A.N.E., April 2004, Vol. 9, No.2, 180 - 186.
2. Journal of Electrocardiology 42 (2009) 120 - 127.

(Abstract Control Number: 63)