Can We Predict Infarct Related Coronary Arteries of Patients with Acute Inferior Myocardial Infarction from Electrocardiographic Findings?

Öz

Introduction: We aimed to investigate the role of electrocardiography (ECG) findings in determining infarct related coronary arteries of patients hospitalized with a diagnosis of acute inferior myocardial infarction (AIMI). Patients and Methods: The first ECG records taken on admission to hospital and demographic characteristics of 132 patients, who were followed with the diagnosis of AIMI (mean age, 57.3 ± 11, 118 men) in our center between January 2004-January 2009, were evaluated. Results: When coronary angiography were evaluated, it was detected that the infarct-related coronary artery (IRCA) was the right coronary artery (RCA) in 70.4% of all patients, whereas it was circumflex artery (Cx) in 29.6% respectively. It was detected that DIII-ST elevation was higher than DII (94.6% sensivity, and 75.9% specifity, p= 0.001) and there was st depression in aVL and DI leads in cases which IRCA was RCA (88.2% sensivity and 75.2% specifity, p= 0.011). Although ST depression in aVL lead was higher than st depression in DI in cases which RCA was IRCA, this finding was defined statistically significant (%95.7 sensivity; %73.6 specifity; p= 0.016). RCA was the IRCA significantly in patients with inferior wall MI accompanied by right ventricular myocardial infarction (p= 0.005). Although Cx was observed as the culprit artery in cases which was accompanied by posterior wall infarction, no statistically finding was detected (p= 0.3). ST-depression was detected in V1-2 leads in ECG of patients whose culprit artery was Cx (%84.6 sensitivity, %36.3 specificity, p= 0.009). Conclusion: The findings based on surface ECG of the patients who underwent AIMI shows that IRCA can be predicted.

Anahtar Kelimeler

• Acute inferior myocardial infarction; electrocardiography; coronary arteries; thrombosis, coronary.

Akut İnferiyor Miyokart Enfarktüsünde İlk Başvuru Anındaki Elektrokardiyografi ile Enfarktüsten Sorumlu Koroner Arteri Tahmin Edebilir miyiz?

Öz

Giriş: Akut inferiyor miyokart enfarktüsü (AİME) tanısıyla hastaneye yatırılan olguların enfarktüsten sorumlu koroner arterlerinin belirlenmesinde elektrokardiyografi (EKG) bulgularının önemini araştırdık. Hastalar ve Yöntem: Merkezimizde Ocak 2004-Ocak 2009 tarihleri arasında AİME tanısı ile takip edilen 132 hastanın (ortalama yaş; 57.3 ± 11, 118 erkek); hastaneye başvuru sırasında çekilen ilk EKG kayıtları ve demografik özellikleri retrospektif olarak değerlendirildi. Bulgular: Koroner anjiyografi tetkikleri değerlendirildiğinde; olguların %70.4'ünde enfarktüsten sorumlu koroner arterin (ESKA) sağ koroner arter (RCA), %29.6'sında sirkumfleks arter (Cx) olduğu saptandı. Sorumlu arterin RCA olduğu olgularda; DIII derivasyonundaki ST segment yükselmesinin, DII derivasyonundan daha fazla olduğu (%94.6 duyarlılık, %75.9 özgüllük, p= 0.001),aVL ve DI derivasyonlarının her ikisinde de ST segment çökmesinin bulunduğu saptandı (%88.2 duyarlılık, %75.2 özgüllük, p= 0.011). Sorumlu arterin RCA olduğu olgulara aVL derivasyonundaki ST segment çökmesinin, DI derivasyonundaki ST segment çökmesinden daha fazla olmasının istatistiksel olarak anlamlı olduğu belirlendi (%95.7 duyarlılık, %73.6 özgüllük p= 0.016). İnferiyor yüz enfarktüse, sağ ventrikül miyokart enfarktüsünün eşlik ettiği hastalarda sorumlu arter anlamlı olarak RCA idi (p= 0.005). Posterior duvar infarktüsünün eşlik ettiği olgularda sorumlu arterin daha çok Cx olduğu gözlense de bu durum istatistiksel olarak anlamlı değildi (p= 0.3). Sorumlu arterin Cx olduğu olguların EKG'lerinde V1-2 derivasyonlarında ST segment çökmesi saptandı (%84.6 duyarlılık, %36.3 özgüllük p= 0.009). Sonuç: AİME geçiren olguların yüzey EKG'lerinden elde edilen bulgular, enfarktüsten sorumlu koroner arterin tahmin edilebileceğini göstermektedir.

Anahtar Kelimeler

• Akut inferiyor miyokart enfarktüsü; elektrokardiyografi; koroner arter tıkanıklığı.

Kaynakça

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