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Easy-to-use ECG algorithm can predict coronary occlusion site in STEMI patients: Study
Italy: A comprehensive and easy-to-use ECG algorithm derived from an extensive literature review can accurately predict the infarct-related artery (IRA) and its occlusion level in all-comers patients with ST-segment elevation myocardial infarction (STEMI), a recent study published in the American Heart Journal.
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.
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751