İnferior ST-Segment Elevasyonlu Miyokard Enfarktüsü Hastalarında Infarkt ile Ilişkili Damarın Öngörülmesinde EKG Kriterleri ve Koroner Arter Baskınlığının EKG Üzerine Etkisi
Abstract
Giriş
Daha önceki çalışmalarda ST-segment yüksekliğinin dağılımının enfarkttan sorumlu damarı öngörebileceği gösterilmiştir. Ancak koroner arter baskınlığının EKG üzerine etkisi yeterince gösterilmemiştir. Bu çalışmada birincil amacımız koroner arter baskınlığının EKG üzerine etkisini araştırdık. İkincil amacımız ise 4. Myokardiyal enfarktüs tanımlaması kılavuzuna göre değişen ST-segment yüksekliği tanımının tanısal değerinin eski tanım ile kıyaslanmasıdır.
Yöntem
Retrospektif olarak primer perkütan girişim ile tedavi edilmiş inferior miyokard enfarktüsü hastaları çalışmaya dahil edildi. Literatür taranarak daha önce tanımlanan şu EKG öngördürücüleri araştırıldı; DIII derivasyonundaki ST-segment elevasyon miktarı DII'den fazla ise infarkttan sorumlu arter sağ koroner arterdir(RCA), aVL veya DI'de ST-segment depresyonu mevcut ise sorumlu arter yine RCA’dır ve DII ST-segment elevasyonu DIII'den fazla ise sorumlu arter Sirkumflex(LCX) arter sorumludur.
Bulgular
Çalışmamızda 192 hasta dahil edildi. 151 hastada sorumlu arter RCA, 41 hastada LCX idi.DIII ST-segment elevasyonunun DII'den fazla olmasının RCA oklüzyonunu göstermede duyarlılığı %84 özgüllüğü %35 olarak saptandı. DII ST-segment elevasyonunun DIII'den fazla olmasının LCX oklüzyonunu göstermede duyarlılığı %48 ve özgüllüğü %65 olarak saptandı. Duyarlılık ve özgüllük açısından en yüksek oran coroner arter baskınlığını öngörmede izlendi; DIII ST-segment elevasyonunun DII'den fazla olmasının koroner arter baskınlığını göstermede duyarlılığı %97 ve özgüllüğü ise %27 olarak saptandı. ST-segment elevasyon miktarının ölçümü için güncel kılavuz önerisi olarak J noktası yerine QRS başlangıcı olarak seçilmesi RCA oklüzyonu olan hastalarda anlamlı değişikliğe neden olmuştur(p: 0.021) ancak LCX oklüzyonu olan hastalarda bu anlamlı değişimin izlenmemiştir(p: 0.212).
Sonuç
Bu çalışmamızda infarkttan sorumlu arteri öngörmek için kullanılan EKG kriterlerinin koroner arter baskınlığına güçlü bir şekilde ilişkili olduğunu gösterdik. Ayrıca yeni EKG kriterleri, RCA oklüzyonu olan hastalarda EKG'nin tanısal doğruluğunu artırdığını ancak LCX oklüzyonu olan hastalarda anlamlı değişiklik yapmadığını gösterdik.
Anahtar sözcükler: inferior STEMI, EKG, Koroner arter baskınlığı
Keywords
References
- Referans1 Arslan F, Bongartz L, ten Berg JM, Jukema JW, Appelman Y, Liem AH, de Winter RJ, van ’t Hof AWJ, Damman P (2018) 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: comments from the Dutch ACS working group. Netherlands Hear J 26:417–421
- Referans2 Sousa-Uva M, Ahlsson A, Alfonso F, et al 2018 ESC/EACTS Guidelines on myocardial revascularization The Task Force on myocardial revascularization of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association for Percutaneous Cardiovascular Interventions (EAPCI). https://doi.org/10.1093/eurheartj/ehy394
- Referans3 Chiang A, Gada H, Kodali SK, et al (2014) Procedural variation in the performance of primary percutaneous coronary intervention for ST-elevation myocardial infarction: A SCAI-based survey study of US interventional cardiologists. Catheter Cardiovasc Interv 83:721–726
- Referans4 Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E Braunwald’s heart disease : a textbook of cardiovascular medicine.
- Referans5 Verouden NJ, Barwari K, Koch KT, et al (2009) Distinguishing the right coronary artery from the left circumflex coronary artery as the infarct-related artery in patients undergoing primary percutaneous coronary intervention for acute inferior myocardial infarction. Europace 11:1517–21
- Referans6 Eerdekens R, Chavez JF, Fox JM, Flaherty JD, Dekker LRC, Johnson NP (2017) Predicting the infarct-related artery in STEMI from the surface ECG: Independent validation of proposed criteria. EuroIntervention 13:953–961
- Referans7 Herz I, Assali AR, Adler Y, Solodky A, Sclarovsky S (1997) New electrocardiographic criteria for predicting either the right or left circumflex artery as the culprit coronary artery in inferior wall acute myocardial infarction. Am J Cardiol 80:1343–5
- Referans8 Zimetbaum PJ, Krishnan S, Gold A, Carrozza JP, Josephson ME (1998) 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 81:918–9
- Referans9 Thygesen K, Alpert JS, Jaffe AS, et al (2019) Fourth universal definition of myocardial infarction (2018). Eur Heart J 40:237–269
- Referans10 Thygesen K, Alpert JS, Jaffe AS, et al (2012) Third universal definition of myocardial infarction. Eur Heart J 33:2551–2567
- Referans11 Zhong-qun Z, Wei W, Shu-yi D, Chong-quan W, Jun-feng W, Zheng C (2009) Electrocardiographic characteristics in angiographically documented occlusion of the dominant left circumflex artery with acute inferior myocardial infarction: limitations of ST elevation III/II ratio and ST deviation in lateral limb leads. J Electrocardiol 42:432–439
- Referans12 Kabakci G, Yildirir A, Yildiran L, Batur MK, Cagrikul R, Onalan O, Tokgozoglu L, Oto A, Ozmen F, Kes S (2001) The diagnostic value of 12-lead electrocardiogram in predicting infarct-related artery and right ventricular involvement in acute inferior myocardial infarction. Ann Noninvasive Electrocardiol 6:229–235
- Referans13 Khan AR, Golwala H, Tripathi A, Bin Abdulhak AA, Bavishi C, Riaz H, Mallipedi V, Pandey A, Bhatt DL (2017) Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analysis. Eur Heart J 38:3082–3089
- Referans14 Daly MJ, Scott PJ, Harbinson MT, Adgey JA (2019) Improving the Diagnosis of Culprit Left Circumflex Occlusion With Acute Myocardial Infarction in Patients With a Nondiagnostic 12-Lead ECG at Presentation: A Retrospective Cohort Study. J Am Heart Assoc. https://doi.org/10.1161/JAHA.118.011029
- Referans15 Couture EL, Bérubé S, Dalery K, Gervais A, Harvey R, Nguyen M, Parenteau É, Daneault B (2016) Culprit Vessel Revascularization Prior to Diagnostic Angiography as a Strategy to Reduce Delays in Primary Percutaneous Coronary Intervention: A Propensity-Matched Analysis. Circ Cardiovasc Interv 9:e003510
ECG Criteria for the Prediction of Infarct-Related Artery and Impact of Coronary Dominance on ECG in Patients with Inferior ST-elevation Myocardial Infarction
Abstract
Background
In-stent restenosis(ISR) is a common angiographic finding in patients with previous stent implantation. Although the mechanism and predictors of ISR has been well-defined, after definition of neoatherosclerosis, a new perspective was emerged and current guidelines recommended a new classification for myocardial infarction due to stent restenosis(Type 4C). In this study, we aimed to investigate the clinical risk factors and predictors of Type 4C myocardial infarction.
Material/method
We reviewed the local angiography database and patients diagnosed with ISR were extracted. Patients’ demographics, clinical characteristics and clinical outcomes were recorded. Type 4C myocardial infarction is defined as myocardial infarction due to stent restenosis.
Results
332 patients were screened and after exclusion 192 patients were included to the final analyses. There were 32 patients with myocardial infarction(group 1). Mean follow-up time was …. months. There was no significant difference between groups with respect to age and gender. Hypertension was significantly more prevalent in group 2. Diabetes mellitus, previous cerebrovascular accident and hyperlipidaemia were comparable between groups, however smoking was significantly more prevalent in group 1. Logistic regression analyses revealed that smoking status and degree of stenosis due to ISR were only independent predictors of type 4C myocardial infarction. Cardiac mortality was significantly increased in patients with myocardial infarction.
Conclusion
Our study demonstrated that type 4C myocardial infarction should not be underestimated during the long-term follow-up of patients who were diagnosed with ISR. Moreover, since cardiac mortality significantly increases in patients with myocardial infarction, future studies for predictors of myocardial infaction is required.
Keywords
References
- Referans1 Arslan F, Bongartz L, ten Berg JM, Jukema JW, Appelman Y, Liem AH, de Winter RJ, van ’t Hof AWJ, Damman P (2018) 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: comments from the Dutch ACS working group. Netherlands Hear J 26:417–421
- Referans2 Sousa-Uva M, Ahlsson A, Alfonso F, et al 2018 ESC/EACTS Guidelines on myocardial revascularization The Task Force on myocardial revascularization of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association for Percutaneous Cardiovascular Interventions (EAPCI). https://doi.org/10.1093/eurheartj/ehy394
- Referans3 Chiang A, Gada H, Kodali SK, et al (2014) Procedural variation in the performance of primary percutaneous coronary intervention for ST-elevation myocardial infarction: A SCAI-based survey study of US interventional cardiologists. Catheter Cardiovasc Interv 83:721–726
- Referans4 Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E Braunwald’s heart disease : a textbook of cardiovascular medicine.
- Referans5 Verouden NJ, Barwari K, Koch KT, et al (2009) Distinguishing the right coronary artery from the left circumflex coronary artery as the infarct-related artery in patients undergoing primary percutaneous coronary intervention for acute inferior myocardial infarction. Europace 11:1517–21
- Referans6 Eerdekens R, Chavez JF, Fox JM, Flaherty JD, Dekker LRC, Johnson NP (2017) Predicting the infarct-related artery in STEMI from the surface ECG: Independent validation of proposed criteria. EuroIntervention 13:953–961
- Referans7 Herz I, Assali AR, Adler Y, Solodky A, Sclarovsky S (1997) New electrocardiographic criteria for predicting either the right or left circumflex artery as the culprit coronary artery in inferior wall acute myocardial infarction. Am J Cardiol 80:1343–5
- Referans8 Zimetbaum PJ, Krishnan S, Gold A, Carrozza JP, Josephson ME (1998) 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 81:918–9
- Referans9 Thygesen K, Alpert JS, Jaffe AS, et al (2019) Fourth universal definition of myocardial infarction (2018). Eur Heart J 40:237–269
- Referans10 Thygesen K, Alpert JS, Jaffe AS, et al (2012) Third universal definition of myocardial infarction. Eur Heart J 33:2551–2567
- Referans11 Zhong-qun Z, Wei W, Shu-yi D, Chong-quan W, Jun-feng W, Zheng C (2009) Electrocardiographic characteristics in angiographically documented occlusion of the dominant left circumflex artery with acute inferior myocardial infarction: limitations of ST elevation III/II ratio and ST deviation in lateral limb leads. J Electrocardiol 42:432–439
- Referans12 Kabakci G, Yildirir A, Yildiran L, Batur MK, Cagrikul R, Onalan O, Tokgozoglu L, Oto A, Ozmen F, Kes S (2001) The diagnostic value of 12-lead electrocardiogram in predicting infarct-related artery and right ventricular involvement in acute inferior myocardial infarction. Ann Noninvasive Electrocardiol 6:229–235
- Referans13 Khan AR, Golwala H, Tripathi A, Bin Abdulhak AA, Bavishi C, Riaz H, Mallipedi V, Pandey A, Bhatt DL (2017) Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analysis. Eur Heart J 38:3082–3089
- Referans14 Daly MJ, Scott PJ, Harbinson MT, Adgey JA (2019) Improving the Diagnosis of Culprit Left Circumflex Occlusion With Acute Myocardial Infarction in Patients With a Nondiagnostic 12-Lead ECG at Presentation: A Retrospective Cohort Study. J Am Heart Assoc. https://doi.org/10.1161/JAHA.118.011029
- Referans15 Couture EL, Bérubé S, Dalery K, Gervais A, Harvey R, Nguyen M, Parenteau É, Daneault B (2016) Culprit Vessel Revascularization Prior to Diagnostic Angiography as a Strategy to Reduce Delays in Primary Percutaneous Coronary Intervention: A Propensity-Matched Analysis. Circ Cardiovasc Interv 9:e003510
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | December 15, 2020 |
| Submission Date | August 5, 2020 |
| Published in Issue | Year 2020 Volume: 10 Issue: 4 |
Cite
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