CORRELATION OF SEVERITY OF ST SEGMENT ELEVATION IN ACUTE INFERIOR WALL MYOCARDIAL INFARCTION WITH THE PROXIMITY OF RIGHT CORONARY ARTERY DISEASE
AbstractBackground: A number of researchers have used different electrocardiographical criteria to predictthe culprit vessel in acute inferior wall myocardial infarction (MI) cases. Therefore, thedetermination of infarct related artery in AMI is extremely important with regard to prediction ofpotential complications, furthermore, predicting the probable site of occlusion within RCA isworthwhile because proximal occlusions are likely to cause greater myocardial damage and an earlyinvasive strategy may be planned in such cases. Our study aimed at evaluating the ECG criteria topredict 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 severityof ST segment elevation in inferior ECG leads. This cross-sectional study carried out at thedepartment of cardiology and cardiac catheterization at Jinnah Hospital, Lahore from April 2008 toSeptember 2008. Methods: A total of 60 patients who suffered from inferior wall MI were includedin the study who underwent coronary angiography in the first week. The ECGs of these patients werethen compared with the angiographic findings to correlate the proximity of culprit lesion in RCAwith 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. Patientswith proximal RCA disease showed a mean ST segment elevation of 12.55±1.38 mm, with mid RCAdisease 8.39±0.89 mm and with distal RCA disease 6.0±0.54 mm. Conclusion: This studydemonstrated that the severity of ST segment elevation was correlated with proximity of RCA lesionKeywords: Right coronary artery, ST elevation MI, Acute Myocardial infarction
Boersma E, Mercado N, Poldermans D, Gardien M, Vos J,
Simoons ML. Acute myocardial infarction. Lancet
Correale E, Battista R, Martone A, Pietropaolo F,
Ricciardiello V, Digirolamo D, et al. Electrocardiographic
patterns in acute inferior myocardial infarction with and
without right ventricle involvement: classification, diagnostic
and prognostic value, masking effect. Clin Cardiol
Khan S, Kundi A, Sharieff S. Prevalence of right ventricular
1.5 2 2.5 3
= Proximal, 2=Mid, 3= Distal RCA infarction
Distal level RCA infarct
Proximal RCA infarct
R Sq Linear = 0.817
J Ayub Med Coll Abbottabad 2008;20(4)
myocardial infarction in patients with acute inferior wall
myocardial infarction. International Journal of Clinical
Practice April 2004;58:354–7.
Iqbal MJ, Azhar M, Javed MT, Tahira I. Study on STsegment elevation acute myocardial infarction in diabetic and
non-diabetic patients. Pak J Med Sci 2008;24:786–91.
Berger PB, Ryan TJ. Inferior myocardial infarction: high risk
subsets. Circulation 1990;81:401–11.
Khan A, Raza A. Khan AAU, Aziz A, Yousaf M. Incidence
and clinical implication of right ventricular infarct. Pak
Armed Forces Med J 1993;43(1):32–4.
Antman EM, Brawunwald E. Acute myocardial infarction.
In: Braunwald E, Zipes DP, Libby P, editors. Heart disease.
A textbook of cardiovascular medicine. 8th ed. Philadelphia:
WB Saunders Company, 2008;p 1135–9.
Candan I, Oral D, editors. Kardyoloji. 1st ed. Ankara: Ankara
Galla JM, Mukherjee D. Complications of myocardial
infarction. In: Griffin BP, Topol EJ, editors. Manual of
cardiovascular medicine. 3rd ed. Philadelphia: Lippincott
Williams & Wilkins, 2009;p 48–66.
Manka R, Fleck E, Paetsch I. Silent inferior myocardial
infarction with extensive right ventricular scarring. Intern J
Samadikhah J, Hakim SH, Asl AA, Azarfarin R, Ghaffari S,
Khalili A. Arrhythmia and conduction disorders in acute
inferior myocardial infarction with right ventricular
involvement. RMJ 2007;32:135–8.
Bayram E, Atalay C. Identification of the culprit artery
involved in inferior wall acute myocardial infarction using
electrocardoigraphic criteria. J Int Med Res 2004;32:39-44.
Zimetbaum PJ, Krishnan S, Gold A, Carrozza JP, Josephson
ME. Usefulness of ST-segment elevation in Lead III
exceeding that of lead II for identifying the location of the
totally occluded coronary artery in inferior wall myocardial
infarction. Am J Cardiol 1998;81:918–9.
Chia BL, Yip JW, Tan HC, Lim YT. Usefulness of ST
elevation II/III ratio and ST deviation in lead I for identifying
the culprit artery in inferior wall acute myocardial infarction.
Am J Cardiol 2000;86:341–3.
Sag C, Ozkan M, Uzun M, Yokusoglu M, Baysan O, Erinc
K, et al. Relationship between coronary risk calculation and
distribution of the coronary artery lesions and risk factors.
Anadolu Kardiyol Derg 2006;6:353–7.
Berry C, ZalewskiA, Kovach R, Savage M, Goldberg S.
Surface electrocardiogram in detection of transmural
myocardial ischemia during coronary artery occlusion. Am J
Cadwell MA, Froelicter ES, Drew BJ. Prehospital delay time
in acute myocardial infarction: an exploratory study on
relation to hospital outcomes and cost. Am Heart J
Fiol M, Carrillo A, Cygankiewicz I, Ayestarản J, Caldẻs O,
Peral V, et al. New criteria based on ST changes in 12-Lead
surface ECG to detect proximal versus distal right coronary
artery occlusion in a case of acute inferoposterior myocardial
infarction. Ann Noninvasive Electrocardiol 2004;9:383–8.
Erdem A, Yilmaz MB, Yalta K, Turgut OO, Tandogan I. The
severity of ST segment elevation in acute inferior myocardial
infarction: Does it predict the presence of a proximal culprit
lesion along the right coronary artery course? Anadolu
Kardiyol Derg 2007;7:189–90.
Ali M, Rana SI, Shafi S, Nazeer M. In hospital outcome of
acute inferior wall MI with or without right ventricular
infarction. Ann King Edward Med Coll 2004;10:420–2.
Zehnder M, Kasper WW, Kander E, Schonthaler M,
Olschewskim, Just H. Comparison of diagnostic accuracy,
time dependency and prognostic impact of Q waves.
Combined electrocardiographic criteria and ST segment
abnormalities in right ventricular infarction. Br Heart
Clinical interpretation and significance of ST changes. In:
Luna AB, Sala MF, Antman EM, editors. The 12-Lead ECG
in ST elevation myocardial infarction. Massachusetts:
Blackwell Publishing, 2007;p 15–54.