Abstract
Patients with electrocardiographic (ECG) left ventricular hypertrophy (LVH) have repolarization abnormalities of the ST segment that may be confused with an ischemic current of injury. We analyzed the ACTIVATE-SF database, a registry of consecutive emergency department ST-segment elevation (STE) myocardial infarction diagnoses from 2 medical centers. Univariate analysis was performed to identify ECG variables associated with presence of an angiographic culprit lesion. Recursive partitioning was then applied to identify a clinical decision-making rule that maximizes sensitivity and specificity for presence of an angiographic culprit lesion. Seventy-nine patients with ECG LVH underwent emergency cardiac catheterization for primary angioplasty. Patients with a culprit lesion had greater magnitude of STE (3.0 ± 1.8 vs 1.9 ± 1.0 mm, p = 0.005), more leads with STE (3.1 ± 1.6 vs 2.0 ± 1.8 leads, p = 0.002), and a greater ratio of STE to R-S-wave magnitude (median 25% vs 9.2%, p = 0.003). Univariate application of ECG criteria had limited sensitivity and a high false-positive rate for identifying patients with an angiographic culprit lesion. In patients with anterior territory STE, using a ratio of ST segment to R-S-wave magnitude <25% as a diagnostic criteria for STE myocardial infarction significantly improved specificity for an angiographic culprit lesion without decreasing sensitivity (c-statistic 0.82), with a net reclassification improvement of 37%. In conclusion, application of an ST segment to R-S-wave magnitude <25% rule may augment current criteria for determining which patients with ECG LVH should undergo primary angioplasty.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 977-983 |
| Number of pages | 7 |
| Journal | American Journal of Cardiology |
| Volume | 110 |
| Issue number | 7 |
| DOIs | |
| State | Published - Oct 1 2012 |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Electrocardiographic criteria for ST-elevation myocardial infarction in patients with left ventricular hypertrophy. / Armstrong, Ehrin J.; Kulkarni, Ameya R.; Bhave, Prashant D.; Hoffmayer, Kurt S.; MacGregor, John S.; Stein, John C.; Kinlay, Scott; Ganz, Peter; McCabe, James M.
In: American Journal of Cardiology, Vol. 110, No. 7, 01.10.2012, p. 977-983.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Electrocardiographic criteria for ST-elevation myocardial infarction in patients with left ventricular hypertrophy
AU - Armstrong, Ehrin J.
AU - Kulkarni, Ameya R.
AU - Bhave, Prashant D.
AU - Hoffmayer, Kurt S.
AU - MacGregor, John S.
AU - Stein, John C.
AU - Kinlay, Scott
AU - Ganz, Peter
AU - McCabe, James M.
PY - 2012/10/1
Y1 - 2012/10/1
N2 - Patients with electrocardiographic (ECG) left ventricular hypertrophy (LVH) have repolarization abnormalities of the ST segment that may be confused with an ischemic current of injury. We analyzed the ACTIVATE-SF database, a registry of consecutive emergency department ST-segment elevation (STE) myocardial infarction diagnoses from 2 medical centers. Univariate analysis was performed to identify ECG variables associated with presence of an angiographic culprit lesion. Recursive partitioning was then applied to identify a clinical decision-making rule that maximizes sensitivity and specificity for presence of an angiographic culprit lesion. Seventy-nine patients with ECG LVH underwent emergency cardiac catheterization for primary angioplasty. Patients with a culprit lesion had greater magnitude of STE (3.0 ± 1.8 vs 1.9 ± 1.0 mm, p = 0.005), more leads with STE (3.1 ± 1.6 vs 2.0 ± 1.8 leads, p = 0.002), and a greater ratio of STE to R-S-wave magnitude (median 25% vs 9.2%, p = 0.003). Univariate application of ECG criteria had limited sensitivity and a high false-positive rate for identifying patients with an angiographic culprit lesion. In patients with anterior territory STE, using a ratio of ST segment to R-S-wave magnitude <25% as a diagnostic criteria for STE myocardial infarction significantly improved specificity for an angiographic culprit lesion without decreasing sensitivity (c-statistic 0.82), with a net reclassification improvement of 37%. In conclusion, application of an ST segment to R-S-wave magnitude <25% rule may augment current criteria for determining which patients with ECG LVH should undergo primary angioplasty.
AB - Patients with electrocardiographic (ECG) left ventricular hypertrophy (LVH) have repolarization abnormalities of the ST segment that may be confused with an ischemic current of injury. We analyzed the ACTIVATE-SF database, a registry of consecutive emergency department ST-segment elevation (STE) myocardial infarction diagnoses from 2 medical centers. Univariate analysis was performed to identify ECG variables associated with presence of an angiographic culprit lesion. Recursive partitioning was then applied to identify a clinical decision-making rule that maximizes sensitivity and specificity for presence of an angiographic culprit lesion. Seventy-nine patients with ECG LVH underwent emergency cardiac catheterization for primary angioplasty. Patients with a culprit lesion had greater magnitude of STE (3.0 ± 1.8 vs 1.9 ± 1.0 mm, p = 0.005), more leads with STE (3.1 ± 1.6 vs 2.0 ± 1.8 leads, p = 0.002), and a greater ratio of STE to R-S-wave magnitude (median 25% vs 9.2%, p = 0.003). Univariate application of ECG criteria had limited sensitivity and a high false-positive rate for identifying patients with an angiographic culprit lesion. In patients with anterior territory STE, using a ratio of ST segment to R-S-wave magnitude <25% as a diagnostic criteria for STE myocardial infarction significantly improved specificity for an angiographic culprit lesion without decreasing sensitivity (c-statistic 0.82), with a net reclassification improvement of 37%. In conclusion, application of an ST segment to R-S-wave magnitude <25% rule may augment current criteria for determining which patients with ECG LVH should undergo primary angioplasty.
UR - http://www.scopus.com/inward/record.url?scp=84866089728&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84866089728&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2012.05.032
DO - 10.1016/j.amjcard.2012.05.032
M3 - Article
C2 - 22738872
AN - SCOPUS:84866089728
VL - 110
SP - 977
EP - 983
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 7
ER -