Kosuyolu Heart J 2013;16(1)
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Kosuyolu Heart J 2013;16(1):47-53 - doi: 10.5578/kkd.4562
Akut İnferiyor Miyokart Enfarktüsünde İlk Başvuru Anındaki Elektrokardiyografi ile Enfarktüsten Sorumlu Koroner Arteri Tahmin Edebilir miyiz?

Can We Predict Infarct Related Coronary Arteries of Patients with
Acute Inferior Myocardial Infarction from Electrocardiographic Findings?

İlker Gül1, Hasan Güngör2, Bekir Serhat Yıldız3, Günay Güneş4, Murat Bilgin5, Ahmet Çağrı Aykan1,
Tayyar Gökdeniz1, Mehdi Zoghi6


1 Department of Cardiology, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital,

Trabzon, Turkey

2 Department of Cardiology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey

3 Department of Cardiology, Denizli State Hospital, Denizli, Turkey

4 Department of Cardiology, Usak State Hospital, Usak, Turkey

5 Department of Cardiology, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

6 Department of Cardiology, Faculty of Medicine, Ege University Izmir, Turkey

ABSTRACT

Introduction: We aimed to investigate the role of electrocardiography (ECG) findings in determining infarct related coronary arteries of patients hospitalized with a diagnosis of acute inferior myocardial infarction (AIMI).

Patients and Methods: The first ECG records taken on admission to hospital and demographic characteristics of 132 patients, who were followed with the diagnosis of AIMI (mean age, 57.3 ± 11, 118 men) in our center between January 2004-January 2009, were evaluated.

Results: When coronary angiography were evaluated, it was detected that the infarct-related coronary artery (IRCA) was the right coronary artery (RCA) in 70.4% of all patients, whereas it was circumflex artery (Cx) in 29.6% respectively. It was detected that DIII-ST elevation was higher than DII (94.6% sensivity, and 75.9% specifity, p= 0.001) and there was st depression in aVL and DI leads in cases which IRCA was RCA (88.2% sensivity and 75.2% specifity, p= 0.011). Although ST depression in aVL lead was higher than st depression in DI in cases which RCA was IRCA, this finding was defined statistically significant (%95.7 sensivity; %73.6 specifity; p= 0.016). RCA was the IRCA significantly in patients with inferior wall MI accompanied by right ventricular myocardial infarction (p= 0.005). Although Cx was observed as the culprit artery in cases which was accompanied by posterior wall infarction, no statistically finding was detected (p= 0.3). ST-depression was detected in V1-2 leads in ECG of patients whose culprit artery was Cx (%84.6 sensitivity, %36.3 specificity, p= 0.009).

Conclusion: The findings based on surface ECG of the patients who underwent AIMI shows that IRCA can be predicted.

Key Words: Acute inferior myocardial infarction; electrocardiography; coronary arteries; thrombosis, coronary.

Geliş Tarihi: 16.11.2012 Kabul Tarihi: 28.11.2012

Correspondence

Dr. İlker Gül

Ahi Evren Göğüs ve Kalp Damar

Cerrahisi Eğitim ve Araştırma Hastanesi,

Kardiyoloji Kliniği, Soğuksu Mahallesi,

Trabzon-Türkiye

e-posta: drilkergul@gmail.com

Akut İnferiyor Miyokart Enfarktüsünde İlk Başvuru Anındaki Elektrokardiyografi ile Enfarktüsten Sorumlu Koroner Arteri Tahmin Edebilir miyiz?

Akut İnferiyor Miyokart Enfarktüsünde İlk Başvuru Anındaki Elektrokardiyografi ile
Enfarktüsten Sorumlu Koroner Arteri Tahmin Edebilir miyiz?

Can We Predict Infarct Related Coronary Arteries of Patients with
Acute Inferior Myocardial Infarction from Electrocardiographic Findings?

İlker Gül1, Hasan Güngör2, Bekir Serhat Yıldız3, Günay Güneş4, Murat Bilgin5, Ahmet Çağrı Aykan1,
Tayyar Gökdeniz1, Mehdi Zoghi6


1 Ahi Evren Göğüs ve Kalp Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Trabzon, Türkiye

1 Department of Cardiology, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital,

Trabzon, Turkey

2 Adnan Menderes Tıp ve Sağlık Bilimleri Merkezi Araştırma ve Uygulama Hastanesi, Kardiyoloji Kliniği,

Aydın, Türkiye

2 Department of Cardiology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey

3 Denizli Devlet Hastanesi, Kardiyoloji Kliniği, Denizli, Türkiye

3 Department of Cardiology, Denizli State Hospital, Denizli, Turkey

4 Uşak Devlet Hastanesi, Kardiyoloji Kliniği, Uşak, Türkiye

4 Department of Cardiology, Usak State Hospital, Usak, Turkey

5 Ankara Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Ankara, Türkiye

5 Department of Cardiology, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

6 Ege Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İzmir, Türkiye

6 Department of Cardiology, Faculty of Medicine, Ege University Izmir, Turkey

ÖZET  

Giriş: Akut inferiyor miyokart enfarktüsü (AİME) tanısıyla hastaneye yatırılan olguların enfarktüsten sorumlu koroner arterlerinin belirlenmesinde elektrokardiyografi (EKG) bulgularının önemini araştırdık.

Hastalar ve Yöntem: Merkezimizde Ocak 2004-Ocak 2009 tarihleri arasında AİME tanısı ile takip edilen 132 hastanın (ortalama yaş; 57.3 ± 11, 118 erkek); hastaneye başvuru sırasında çekilen ilk EKG kayıtları ve demografik özellikleri retrospektif olarak değerlendirildi.

Bulgular: Koroner anjiyografi tetkikleri değerlendirildiğinde; olguların %70.4'ünde enfarktüsten sorumlu koroner arterin (ESKA) sağ koroner arter (RCA), %29.6'sında sirkumfleks arter (Cx) olduğu saptandı. Sorumlu arterin RCA olduğu olgularda; DIII derivasyonundaki ST segment yükselmesinin, DII derivasyonundan daha fazla olduğu (%94.6 duyarlılık, %75.9 özgüllük, p= 0.001), aVL ve DI derivasyonlarının her ikisinde de ST segment çökmesinin bulunduğu saptandı (%88.2 duyarlılık, %75.2 özgüllük, p= 0.011). Sorumlu arterin RCA olduğu olgulara aVL derivasyonundaki ST segment çökmesinin, DI derivasyonundaki ST segment çökmesinden daha fazla olmasının istatistiksel olarak anlamlı olduğu belirlendi (%95.7 duyarlılık, %73.6 özgüllük p= 0.016). İnferiyor yüz enfarktüse, sağ ventrikül miyokart enfarktüsünün eşlik ettiği hastalarda sorumlu arter anlamlı olarak RCA idi (p= 0.005). Posterior duvar infarktüsünün eşlik ettiği olgularda sorumlu arterin daha çok Cx olduğu gözlense de bu durum istatistiksel olarak anlamlı değildi (p= 0.3). Sorumlu arterin Cx olduğu olguların EKG'lerinde V1-2 derivasyonlarında ST segment çökmesi saptandı (%84.6 duyarlılık, %36.3 özgüllük p= 0.009).

Sonuç: AİME geçiren olguların yüzey EKG'lerinden elde edilen bulgular, enfarktüsten sorumlu koroner arterin tahmin edilebileceğini göstermektedir.

Anahtar Kelimeler: Akut inferiyor miyokart enfarktüsü; elektrokardiyografi; koroner arter tıkanıklığı.

Received: 16.11.2012 Accepted: 28.11.2012

ABSTRACT

Introduction: We aimed to investigate the role of electrocardiography (ECG) findings in determining infarct related coronary arteries of patients hospitalized with a diagnosis of acute inferior myocardial infarction (AIMI).

Patients and Methods: The first ECG records taken on admission to hospital and demographic characteristics of 132 patients, who were followed with the diagnosis of AIMI (mean age, 57.3 ± 11, 118 men) in our center between January 2004-January 2009, were evaluated.

Results: When coronary angiography were evaluated, it was detected that the infarct-related coronary artery (IRCA) was the right coronary artery (RCA) in 70.4% of all patients, whereas it was circumflex artery (Cx) in 29.6% respectively. It was detected that DIII-ST elevation was higher than DII (94.6% sensivity, and 75.9% specifity, p= 0.001) and there was st depression in aVL and DI leads in cases which IRCA was RCA (88.2% sensivity and 75.2% specifity, p= 0.011). Although ST depression in aVL lead was higher than st depression in DI in cases which RCA was IRCA, this finding was defined statistically significant (%95.7 sensivity; %73.6 specifity; p= 0.016). RCA was the IRCA significantly in patients with inferior wall MI accompanied by right ventricular myocardial infarction (p= 0.005). Although Cx was observed as the culprit artery in cases which was accompanied by posterior wall infarction, no statistically finding was detected (p= 0.3). ST-depression was detected in V1-2 leads in ECG of patients whose culprit artery was Cx (%84.6 sensitivity, %36.3 specificity, p= 0.009).

Conclusion: The findings based on surface ECG of the patients who underwent AIMI shows that IRCA can be predicted.

Key Words: Acute inferior myocardial infarction; electrocardiography; coronary arteries; thrombosis, coronary.

Geliş Tarihi: 16.11.2012 Kabul Tarihi: 28.11.2012

Yazışma Adresi/Correspondence

Dr. İlker Gül

Ahi Evren Göğüs ve Kalp Damar

Cerrahisi Eğitim ve Araştırma Hastanesi,

Kardiyoloji Kliniği, Soğuksu Mahallesi,

Trabzon-Türkiye

e-posta: drilkergul@gmail.com

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