The role of ECG in localizing culprit vessel occlusion in acute ST segment elevation myocardial infarction with echocardiographic correlation: ECG and echo in conjunction for better management of STEMI

Abstract Objective Characteristic changes on electrocardiogram (ECG) along with left ventricular ejection fraction (LVEF) and regional wall motion abnormality (RWMA) detected by 2D-Echo helps in diagnosis and prognostication of myocardial infarction (MI). Hence, this study was undertaken to localize the site of infarction in acute ST segment elevation myocardial infarction (STEMI) by ECG and correlate it with RWMA on 2D-Echo. Methods This was a prospective study on 100 consecutive selected patients and detailed clinical history was taken. On the basis of admission ECG, patients were broadly classified into three subgroups i.e. anterior wall myocardial infarction (AWMI), inferior wall myocardial infarction (IWMI), anterior plus inferior wall MI. 2D-Echo was done and the culprit vessel localized on the ECG was thereafter correlated with the RWMA on 2D-Echo. Results The localization of culprit vessel territory on ECG broadly correlated with RWMA on 2D-Echo. Echo could elaborate the territory of infarction in greater detail than ECG. The Sensitivity, Specificity, Positive Predictive Value and Negative Predictive Value (PPV and NPV) of ECG compared to 2D-Echo in LAD territory were 96.6%, 85.3%, 90.5% and 94.6% and in RCA territory it was 93.3%, 92.8%, 84.8% and 97% and for LCx it was 50%, 98.9%, 75% and 96.8% respectively. Conclusions ECG proved to be relatively sensitive and specific investigation for diagnosis of acute STEMI. 2D-Echo supplements and supports ECG by elaborating the regions involved in MI. Therefore both ECG and Echo should be used in conjunction for better assessment of prognosis and management of the patient.