The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Features of electrocardiogram in patients with stenosis of the proximal right coronary artery

  • Koh, Moo Seong (Department of Emergency Medicine, Dong-A University College of Medicine) ;
  • Lee, Jae Hoon (Department of Emergency Medicine, Dong-A University College of Medicine) ;
  • Jeong, Jin Woo (Department of Emergency Medicine, Dong-A University College of Medicine) ;
  • Chung, Jun Young (Department of Emergency Medicine, Dong-A University College of Medicine)
  • Received : 2015.04.26
  • Accepted : 2015.09.14
  • Published : 2017.03.01
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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 circumflex 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 depression (${\leq}0mm$) 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.

Keywords

Acknowledgement

Supported by : Dong-A University

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