Clinical significance of frontal ST segment vector for identifying coronary segmental lesions in I-STEMI
Objective To investigate the clinical value of using ST-segment vector(ST-VF)analysis in determining the coronary artery involvement in inferior wall ST-elevation myocardial infarction(I-STEMI).Methods This study conducted a retrospective analysis of I-STEMI cases over the past decade across the Affiliated Hospital of Zunyi Medi-cal University and the Second Affiliated Hospital of Zunyi Medical University with confirmed single-vessel coronary ar-tery lesions through coronary angiography.Computer software,self-developed,was employed for the automatic measure-ment of 12-lead digital electrocardiogram(ECG)signals,which were subsequently manually corrected.ST-VF and ST electrical axis(ST-AF)were calculated.This study compared the degree of ST-segment elevation in leads Ⅱ and Ⅲ,the magnitude of ST-VF,and the ST-AF among different coronary artery segment lesions.Results Among 572 cases of I-STEMI,417(72.90％)had right coronary artery(RCA)lesions,114(19.93％)had left circumflex artery(LCX)lesions,and 41(7.17％)had left anterior descending artery(LAD)lesions.No significant differences were ob-served in the degree of ST-segment elevation in leads Ⅱ and Ⅲ or the magnitude of ST-VF among various coronary ar-tery segment lesions.ST-AF and ST Ⅱ/ST Ⅲ values showed significant differences among different coronary artery seg-ment lesions,with ST-AF and STⅡ/STⅢ values being mathematically interchangeable.ROC curve analysis revealed a cutoff value of≥114° for RCA proximal-middle segment lesions(AUC:0.96,95％CI:0.95-0.98),a cutoff value of ≤94.46° for LCX proximal segment lesions(AUC:1.0,95％CI:1.0),and an inability to effectively distinguish between LAD middle-distal segment lesions and RCA distal segment or LCX distal segment lesions,the difference was not statistically significant(P＞0.05).Conclusion ST-AF(or STⅡ/STⅢ values)can effectively differentiate between RCA proximal-middle segment lesions and LCX proximal segment lesions but are not effective in distinguishing LAD middle-distal segment,RCA distal segment,or LCX distal segment lesions.
Myocardial infarctionInfarction related arteryST-segment frontal vectorElectrocardiography
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