Korean J Intern Med.  2017 Mar;32(2):277-285. 10.3904/kjim.2015.122.

Features of electrocardiogram in patients with stenosis of the proximal right coronary artery

• Koh MS
• Lee JH
• Jeong JW
• Chung JY

• KMID: 2371650
• DOI: http://doi.org/10.3904/kjim.2015.122

Abstract

BACKGROUND/AIMS
Prediction of lesions of the proximal right coronary artery (pRCA) through electrocardiogram (ECG) is very important because pRCA occlusion has many complications and a high mortality rate, which has frequently been related with right ventricular infarction. The purpose of this study was to devise a screening tool that takes into account multiple leads from a 12-lead ECG to predict the pRCA lesion.
METHODS
A hundred and fifty-eight patients who were diagnosed as acute coronary syndrome and had a pure lesion of RCA or left circumf lex artery (LCX) by ECGs and angiographic findings were enrolled retrospectively. Forty-eight patients with a pure pRCA occlusion were compared to a control group of 110 patients who were diagnosed as having either a pure mid to distal RCA lesion (57 patients) or a pure LCX lesion (53 patients).
RESULTS
ECGs of patients in the pRCA group showed more prominent ST depression in lead I (p = 0.001) and ST elevation in V1 (p = 0.002) than in the control group. The combination of ST depression (≤ 0 mm) in I and ST elevation (> 0.5 mm) in V1 was the best diagnostic tool (area under the curve, 0.84).
CONCLUSIONS
ST changes in leads V1 and I allow more accurate prediction of pRCA occlusion than other criteria, such as the difference between ST elevation of leads II and III or vector direction and amplitude. These variables could help to screen for right ventricular infarction before performing reverse ECG and predicting prognosis.

Keyword

Coronary artery disease; Myocardial infarction; Electrocardiography; Coronary angiography

MeSH Terms

Acute Coronary Syndrome
Arteries
Constriction, Pathologic*
Coronary Angiography
Coronary Artery Disease
Coronary Vessels*
Depression
Electrocardiography*
Humans
Infarction
Mass Screening
Mortality
Myocardial Infarction
Prognosis
Retrospective Studies