Electrocardiographic algorithm for assignment of occluded vessel in acute myocardial infarction

Background: This study was performed to elaborate an electrocardiographic (ECG) algorithm enabling assignment of an occluded coronary artery in acute myocardial infarction (AMI). Patients and Interventions: In 109 patients (age, 59±12 years) with AMI (pain onset, 3.6±1.7 h), coronary angiography with PTCA/stenting of the culprit lesion was performed. The diagnosis of AMI was confirmed by emergency coronary angiography and laboratory analyses. Admission ECG parameters (amplitude of R-wave, ST-segment deviation, presence of Q-wave, deflection of T-wave) in standard 12-lead ECG plus extended (V3R to V6R and V7–9) leads were subjected to classification and regression tree (CART) analysis. Results: Continuous CART analysis assessed ST-segment deviations in V2 and V5R. AMI of the left anterior descending (LAD), right coronary artery (RCA) and left circumflex coronary artery (CX) were correctly classified in 94, 64, and 91% of cases, respectively. Dichotomised CART analysis assessed ST-segment deviations in V2, V5R, and aVF. True classification rates for LAD, RCA, and CX amounted to 84, 74, and 71%, respectively. Conclusions: Dichotomised CART analysis is a simple means of differentiation of CX from RCA occlusion during AMI.