Easy-to-use ECG algorithm can predict coronary occlusion site in STEMI patients: Study

There have been proposals for several electrocardiogram (ECG) criteria to predict the location of the culprit occlusion in specific subsets of patients with STEMI. Considering this, Carlo Gaspardone, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy, and colleagues aimed to develop a comprehensive and easy-to-use ECG algorithm through independent validation of currently available criteria and to test its diagnostic performance in real-world clinical practice.

For this purpose, the researchers analyzed ECG and angiographic data from 419 successive STEMI patients submitted to primary percutaneous coronary intervention over one year; the overall population was divided into derivation (314 patients) and validation (105 patients) cohorts.

In the derivation cohort, the researchers tested >60 previously published ECG criteria using decision-tree analysis to develop the algorithm that would best diagnose the IRA and its occlusion level. Further, the new algorithm diagnostic performance was assessed in the validation cohort.

The study led to the following findings:

• In the derivation cohort, the algorithm correctly predicted the IRA in 88% of cases and both the IRA and its occlusion level (proximal vs. mid-distal) in 71% of cases.
• When applied to the validation cohort, the algorithm resulted in 88% and 67% diagnostic accuracies, respectively.
• In a real-world comparative test, the algorithm performed significantly better than expert physicians in identifying the site of the culprit occlusion.

"The internal validation suggested that the algorithm is reliable and accurate, making it appropriate for clinical practice," the researchers wrote in their conclusion. "This ECG algorithm can predict the culprit occlusion site in all STEMI patients and may be useful for determining prognosis and management guide of these patients."

Reference:

Gaspardone C, Romagnolo D, Fasolino A, Falasconi G, Beneduce A, Fiore G, Didelon E, Fortunato F, Galdieri C, Posteraro GA, Ingallina G, Ancona F, Biondi F, Maio SD, Casiraghi A, Slavich M, Borio G, Savastano S, Leonardi S, Agricola E, Oppizzi M, Gaspardone A, Pappone C, Montorfano M. A comprehensive and easy-to-use ECG algorithm to predict the coronary occlusion site in ST-segment elevation myocardial infarction. Am Heart J. 2022 Oct 19:S0002-8703(22)00272-1. doi: 10.1016/j.ahj.2022.10.077. Epub ahead of print. PMID: 36272451.