The following is the summary of “A comprehensive and easy-to-use ECG algorithm to predict the coronary occlusion site in ST-segment elevation myocardial infarction” published in the January 2023 issue of American Heart Journal by Gaspardone, et al.

Patients presenting with ST-segment elevation myocardial infarction (STEMI) can be classified into subgroups based on the Several electrocardiogram (ECG) criteria proposed to determine the site of the culprit occlusion. The study’s overarching objective was to create a user-friendly ECG algorithm by independently validating existing criteria and then to put it through its diagnostic paces in actual clinical settings. Over the course of a year, researchers studied 419 STEMI patients who underwent primary percutaneous coronary intervention, splitting the population into a derivation (314 patients) and validation (105 patients) group to examine ECG and angiographic data. 

Investigators evaluated more than 60 previously reported ECG criteria in the derivation cohort and used decision-tree analysis to determine the strategy that most accurately predicts the infarct-related artery (IRA) and its blockage level. In addition, they analyzed the diagnostic efficacy of the new algorithm in a separate cohort known as the validation sample. The system has an 88% success rate in predicting the IRA in the derivation cohort and a 71% success rate in predicting the IRA and its occlusion level (proximal vs. mid-distal).

When used on the validation cohort, the algorithm achieved 88% and 67% diagnosis accuracy. As shown in a real-world comparison test, the system outperformed top cardiologists and emergency care specialists in pinpointing the location of the offending blockage (P=.026 and P<.001, respectively). This easy-to-use ECG technique is derived from a comprehensive literature study and can accurately predict the IRA and its occlusion level in all comers with STEMI.