The accuracy of distribution of non-ST elevation electrocardiographic changes in localising the culprit vessel in non-ST elevation myocardial infarction.

Introduction: ST-segment elevation distribution on electrocardiogram (ECG) in patients presenting with ST-elevation myocardial infarction (STEMI) accurately localises the culprit vessel. However, the utility of the ECG changes in localising the coronary culprit territory in the setting of non-ST segment elevation myocardial infarction (NSTEMI) is not well established.

Material and methods: This study included patients presenting with NSTEMI, who had dynamic non-ST elevation ischaemic changes in one or more ECG leads and underwent percutaneous coronary intervention (PCI) in a single vessel between October 2011 and November 2017 in a single university hospital institution. The accuracy, sensitivity, and specificity of the distribution of ECG changes in localising the culprit vessel were calculated.

Results: There was a total of 82 patients included in this study, who received PCI to the left anterior descending (LAD), right coronary artery (RCA), and left circumflex (LCX), in 43.9%, 24.4%, and 31.7%, respectively; 51% were male. In this cohort, sensitivity of ECG in localising single-culprit-vessel NSTEMI was 41.5%. The overall accuracy of ECG changes was 50.0%, 72.0%, and 70.0% in LAD, RCA, and LCX distribution, respectively. The sensitivity and specificity were 72.2% and 32.6% in LAD distribution, 20% and 88.7% in RCA distribution, and 15.4% and 82.1% in LCX distributions, respectively.

Conclusions: Ischaemic non-ST elevation ECG changes had modest accuracy in localising the culprit vessel in patients with PCI-treated NSTEMI. These changes were more sensitive in LAD distribution and more specific in RCA and LCX distributions.