Evaluation of Previous ECG Algorithms for Identifying the Culprit Artery in Inferior STEMI

Abstract Background ST elevation myocardial infarction (STEMI) is the leading cause of cardiovascular related mortality. In the context of Inferior STEMI, the culprit artery is whether the right coronary artery (RCA) or left circumflex coronary artery (LCx). An accurate prediction of culprit artery prior to primary percutaneous coronary intervention (PCI) could improve the door-to-balloon time and could prevent contrast-induced-nephropathy. However algorithms established for that purpose were not evaluated within the Tunisian population. We aimed then to assess their performance in our population Methods We conducted a single-center hostorical cohort study from January 2014 to December 2022 on patients admitted at Sahloul university hospital Sousse Tunisia for PCI following an inferior STEMI. We analyzed the ST segment deviations at the J-point and 80 ms after the J-point then evaluated the performance of previous algorithms. Results We collected data from 156 patients, of which 130 (83.3%) hada RCA occlusion, and 26 (16.7%) a LCx occlusion. We evaluated 19 published algorithms. The criterion of zimetbaum et al (ST elevation in III> II and I and/or VL <-1 mm) had the highest AUC 0.77[0.66 - 0.88] YI = 52 accuracy = 0.81. The criterion of Herz et al (ST III > II) had AUC ROC of 0.71 [0.58 - 0.83] YI = 0.41 accuracy = 0.78, the algorithm of Tierala et al: AUC = 0.70[0.58 - 0.83] YI = 0.40 accuracy = 0.78. The algorithm og Fiol et al: AUC = 0.79 [0.58-0.83] YI = 0.59 accuracy = 0.73. Conclusions The Zimetbaum criterion had the highest performance in predicting the culprit artery and Fiol’s algorithm was the most specific to the LCx occlusion in our population. Further study on the impact of these algorithms on patients outcome is necessary. Key messages • The prediction of the culprit artery in inferior STEMI is challenging. • The criterion of Zimetbaum et al had a good performance for that regard.