Moazzam Ali Naqvi, Muzaffar Ali, Fuad Hakeem, Arslan Masood, Zubair Akram


Background: A number of researchers have used different electrocardiographical criteria to predict
the culprit vessel in acute inferior wall myocardial infarction (MI) cases. Therefore, the
determination of infarct related artery in AMI is extremely important with regard to prediction of
potential complications, furthermore, predicting the probable site of occlusion within RCA is
worthwhile because proximal occlusions are likely to cause greater myocardial damage and an early
invasive strategy may be planned in such cases. Our study aimed at evaluating the ECG criteria to
predict the proximity of lesion in the right coronary artery (RCA) in acute inferior wall MI cases.
The Objectives were to predict the presence of a proximal lesion in right coronary artery by severity
of ST segment elevation in inferior ECG leads. This cross-sectional study carried out at the
department of cardiology and cardiac catheterization at Jinnah Hospital, Lahore from April 2008 to
September 2008. Methods: A total of 60 patients who suffered from inferior wall MI were included
in the study who underwent coronary angiography in the first week. The ECGs of these patients were
then compared with the angiographic findings to correlate the proximity of culprit lesion in RCA
with the degree of ST segment elevation in inferior limb leads. Results: Out of 60 patients, 29
(48.4%) had the culprit lesion in proximal, 23 (38.5%) in mid and 8 (13.4%) in distal RCA. Patients
with proximal RCA disease showed a mean ST segment elevation of 12.55±1.38 mm, with mid RCA
disease 8.39±0.89 mm and with distal RCA disease 6.0±0.54 mm. Conclusion: This study
demonstrated that the severity of ST segment elevation was correlated with proximity of RCA lesion
Keywords: Right coronary artery, ST elevation MI, Acute Myocardial infarction


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6 4

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= Proximal, 2=Mid, 3= Distal RCA infarction

Mid-level RCA

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