| Background and Objective:Some previous studies have explored the value of different electrocardiogram(ECG)indicators for infarction-related artery(IRA)location in different populations with acute myocardial infarction(AMI).However,most of these data come from the era when AMI was mainly treated by thrombolytic,and the inclusion criteria were mostly set to include only single-artery lesions,artificially excluding patients with multi-artery lesions,which may introduce selection bias.The main purpose of this study is to reevaluate the diagnostic value of ECG in IRA location in patients with ST-segment elevation myocardial infarction(STEMI)and explore ECG indicators to determine whether patients with STEMI complicate with ischemic cardiomyopathy.Methods:In this study,patients diagnosed with STEMI and treated by emergency coronary angiography(CAG)in the Department of Cardiovascular Medicine of First hospital of Jilin University from January 2020 to December 2021 were enrolled.ECG parameters were measured and collected including ST-segment offset of each lead,amplitude of each part of QRS complex and duration of each wave and segment)and data of echocardiography and CAG were collected.According to ECG,the patients were divided into acute anterior myocardial infarction(AAMI)and acute inferior myocardial infarction(AIMI).According to the results of CAG,the patients were divided into proximal LAD lesions,middle-distal LAD lesions,proximal RCA lesions,middle-distal RCA lesions and LCX lesions.Sensitivity,specificity,total coincidence,positive predictive value and negative predictive value were used to evaluate the diagnostic value of ECG indicators in the diagnosis of IRA.According to the left ventricular end-diastolic diameter(LVEDD),the patients were divided into ischemic cardiomyopathy(ICM)and non-ischemic cardiomyopathy.Univariate analysis and variance inflation factor test were carried out for potential ECG indicators that may have diagnostic value for complicated ischemic cardiomyopathy.Multivariate logistic regression analysis was conducted to analyze indicators that could effectively diagnose ICM further.Receiver operating characteristic curve(ROC)was used to evaluate the diagnostic value of this index in patients with ICM.Results:(1)There were 442 patients with AAMI,including 264 patients with proximal LAD and 178 middle-distal LAD.No significant difference was observed in age,gender,LVEDD and left ventricular ejection fraction(LVEF)between the two groups.The results of ECG indexes and diagnostic value for occlusion site as proximal LAD were as follows: the sensitivity and specificity of ST-segment depression in at least one lead of II,III and a VF were 89.0% and 60.1%,respectively.The sensitivity and specificity of ST-segment depression in at least two inferior leads were 85.2% and 82.0% respectively.The sensitivity and specificity of ST-segment depression of all inferior leads were 50.8% and 92.1%.The sensitivity and specificity of ST-segment elevation in lead a VL were 64.0% and 79.8% respectively.(2)There were 570 patients with AIMI,including 395 patients in which the IRA was RCA and 175 in which the IRA was LCX.No significant difference was observed in age,gender,LVEDD and LVEF between the two groups.The results of ECG index and diagnostic value for predicting IRA as RCA were as follows: The sensitivity and specificity of STII↑≤STIII↑ were 90.7% and 81.1%,respectively.The sensitivity and specificity of STa VL↓≥STI↓ were 88.9% and 37.1%,respectively.The sensitivity and specificity of STa VL↓≥STa VR↓ were 81.8% and 66.9%,respectively.The sensitivity and specificity of ∑STV1-V3↓/∑STII,III,a VF↑≤1 were 90.1% and 41.1% respectively.The sensitivity and specificity of ST-segment depression in lead I were 84.6% and 73.7%,respectively.The sensitivity and specificity of ST-segment depression in lead a VL were 82.8% and 67.4% respectively.The sensitivity and specificity of ST-segment depression in both I and a VL leads were 82.8% and 75.4%,respectively.The sensitivity and specificity of ST-segment depression in V5 and V6 leads were 50.9% and 62.3%,respectively.The sensitivity and specificity of STV3↓/STIII↑≤1.2 were 92.2% and 29.1%,respectively.(3)The results of ECG index and diagnostic value for predicting IRA as LCX were as follows: The sensitivity and specificity of STII↑>STIII↑ were 81.1% and 90.7%,respectively.The sensitivity and specificity of STV1↓≥0.1m V were 44.6% and 79.0%,respectively.The sensitivity and specificity of STIII↑≤STV6↑ were 38.9% and 97.0%,respectively.The sensitivity and specificity of without ST-segment depression in neither I nor a VL leads were 65.7% and 84.6%,respectively.The sensitivity and specificity of STsegment elevation for V5 and/or V6 leads were 62.3% and 50.9%,respectively.The sensitivity and specificity of ∑STV1-V3↓/∑STII,III,a VF↑>1 were 41.1% and 90.1%,respectively.(4)The results of ECG index and diagnostic value for predicting the occlusion site of proximal RCA in patients whose IRA was RCA were as follows: the sensitivity and specificity of ST-segment elevation of V1 lead were 21.4% and 96.7%,respectively.The sensitivity and specificity of ST-segment elevation for V5 and/or V6 leads were 94.1% and 53.6%,respectively.(5)There were a total of 841 patients with complete echocardiography data,in which 760 patients with ICM and 81 with non-ICM.There were significant differences in gender,LVEDD,LVEF,heart rate,QTc,RIII,RV5,RV6,SV1,SV2 and SV3 between the two groups,and no significant difference in infarct location.Variance inflation factor test showed that there is collinearity between RV5 and RV6.Binary logistic regression analysis showed that SV1,SV3 and RV5 were potential predictors of ICM.ROC curve analysis showed that the sensitivity and specificity of SV1 were 55.6% and 80.0%,respectively and the area under the curve(AUC)was 0.710.The sensitivity and specificity of SV3 were 49.4% and 77.4%,respective and AUC was 0.627.The sensitivity and specificity of RV5 were 51.1% and 77.5%,respectively and AUC was 0.662.The sensitivity and specificity of SV1+RV5 were 62.2% and 84.6%,respectively and AUC was 0.752.Conclusions:(1)The sensitivity of ST-segment depression in at least one lead of II,III and a VF was the highest,and the specificity of ST-segment depression in all leads of II,III and a VF was the highest in predicting the occlusion site of proximal LAD in AAMI.(2)The sensitivity of STV3↓/STIII↑≤1.2 was the highest sensitivity,and the specificity of STII↑≤STIII↑ was the highest in predicting the IRA as RCA in AIMI.(3)The sensitivity of STII↑>STIII↑ was the highest sensitivity,and the specificity of STIII↑≤STV6↑ was the highest in predicting the IRA as LCX in AIMI.(4)The sensitivity of ST-segment elevation in lead V5 and/or V6 was the highest,and the specificity of ST-segment elevation in lead V1 was the highest in predicting the occlusion site of proximal RCA in patients whose IRA was RCA.(5)The ECG index RV5+SV1 had the highest diagnostic value in the diagnosis of STEMI complicated with ICM.The optimal cut-off value is 2.748 mV. |
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