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

Yıl 2013, Cilt: 16 Sayı: 1, 47 - 53, 01.01.2012

İlker Gül Hasan Güngör Bekir Serhat Yıldız Günay Güneş Murat Bilgin Ahmet Çağrı Aykan Tayyar Gökdeniz Mehdi Zoghi

https://doi.org/10.5578/kkd.4562

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

• Nichols M, Townsend N, Scarborough P, Fernandez R. European cardiovascular disease statistics. 2012:8.
• Braunwald E, Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald’s Heart Disase. A Textbook of Cardiovascular Medicine. Philadelp- hia: WB Saunders, 2008:1210-4.
• Wellens JJ, Gorgels A, Doevedans P. The ECG in Acute Myo- cardial infarction and Unstable Angina. Diagnosis and Risk Stra- tification. 2nd ed. Massachusetts: Kluwer Academic Publishers, 2003:13-4.
• Berger PB, Ryan TJ. Inferior myocardial infarction: high risk subg- roups. Circulation 1990;8:401-11.
• O’Rourke MD, Dell’Italia MD. Diagnosis and management of right ventricular myocardial infarction. Curr Probl Cardiol 2004;29:1-47.
• Tygesen K, Alpert JS, White HD. Universal definition of myocardial infarction. J Am Coll Cardiol 2007;50:2173-95.
• Moye S, Carney MF, Holstege C, Mattu A, Brady WJ. The electro- cardiogram in right ventricular myocardial infarction. Am J Emerg Med 2005;23:793-9.
• Wong TW, Huang XH, Liu W, Kenneth N, Siang K. New electro- cardiographic criteria for identifying the culprit artery in inferior wall acute myocardial infarction usefulness of t-wave amplitude ratio in leads II/III and t-wave polarity in the right V5 lead. Am J Cardiol 2004;94:1168-71.
• Kontos MC, Desai PV, Jesse RL, Ornato JP. Usefulness of the admission electrocardiogram for identifying the infarct-related artery in inferior wall acute myocardial infarction. Am J Cardiol 1997;79:182-4.
• Cingözbay BY, Özmen N, Top C, Cebeci BS, Demiralp E. Akut inferior miyokard infarktüsünde infarkttan sorumlu arteri elekt- rokardiyografik olarak tahmin edebilme. Anadolu Kardiyol Derg 2001;1:148-52.
• Kabakci G, Yildirir A, Yildiran L, Batur MK, Cagrikul R, Onalan O et al. The diagnostic value of 12-lead electrocardiogram in predic- ting infarct related artery and right ventricular involvement in acu- te inferior myocardial infarction. Ann Noninvasive Electrocardiol 2001;6:229-35.
• Bayram E, Atalay C. Identification of the culprit artery involved in inferior wall acute myocardial infarction using electrocardiographic criteria. J Int Med Res 2004;32:39-44.
• Birnbaum Y, Sclarovsky S, Mager A, Strasberg B, Rechavia E. ST segment depression in aVL: a sensitive marker for acute inferior myocardial infarction. Eur Heart J 1993;14:4-7.
• Cooksey JD, Dunn M, Massie E. Inferoposterior myocardial infarc- tion. In: Cooksey JD, Dunn M, Massie E (eds). Clinical Vectorcar- diography and Electrocardiography. 2nd ed. Chicago: Year Book Medical Publishers, 1977:391-427.
• Berry C, Zalewski A, Kovach R, Savage M, Goldberg S. Surface electrocardiogram in detection of transmural myocardial ischemia during coronary artery occlusion. Am J Cardiol 1989;63:21-6.
• Birnbaum Y, Wagner GS, Barbash GI, Gates K, Criger DA, Scla- rovsky S, et al. Correlation of angiographic findings and right (V1 to V3) versus left (V4 toV6) precordial ST-segment depression in infe- rior wall acute myocardial infarction. Am J Cardiol 1999;83:143-8.
• Kürüm T, Oztekin E, Ozçelik F, Eker H, Türe M, Ozbay G. Akut İnferior miyokard infarktüsünde sirkumfleks arter ve sağ koroner arter tıkanmasının giriş elektrokardiyogramından ayırımı. Turk Kardiyol Dern Ars 1999;27:681-6.
• Willems JL, Willems RJ, Willems GM, Arnold AE, Van de Werf F, Verstraete M. Significance of initial st segment elevation and depression for the management of thrombolytic therapy in acute myocardial infarction. Circulation 1990;82:1147-58.
• Hasdai D, Birnbaum Y, Herz I, Sclarovsky S, Mazur A, Solodky A. ST segment depression in lateral limb leads in inferior wall acute myocardial infarction. Implications regarding the culprit artery and the site of obstruction. Eur Heart J 1995;16:1549-53.
• Assali AR, Herz I, Vaturi M, Adler Y, Solodky A, Birnbaum Y, et al. Electrocardiographic criteria for predicting the culprit artery in infe- rior wall acute myocardial infarction. Am J Cardiol 1999;84:87-9.