Electrocardiographic localization of coronary artery narrowings: studies during myocardial ischemia and infarction in patients with one-vessel disease

To investigate the accuracy of the 12-lead ECG in localizing the site of coronary artery narrowings, we reviewed abnormal ECGs obtained during myocardial infarction, spontaneous angina or exercise stress testing in 134 patients with angiographically documented one-vessel disease. The presence of Q w...

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Bibliographic Details
Published inCirculation (New York, N.Y.) Vol. 66; no. 6; pp. 1168 - 1176
Main Authors Fuchs, R M, Achuff, S C, Grunwald, L, Yin, F C, Griffith, L S
Format Journal Article
LanguageEnglish
Published United States 01.12.1982
Subjects
Adult
Aged
Angina Pectoris - diagnosis
Angina Pectoris - diagnostic imaging
Arterial Occlusive Diseases - complications
Arterial Occlusive Diseases - diagnosis
Collateral Circulation
Coronary Angiography
Coronary Disease - classification
Coronary Disease - diagnosis
Coronary Disease - etiology
Electrocardiography
Exercise Test
Female
Humans
Male
Middle Aged
Myocardial Infarction - diagnosis
Myocardial Infarction - etiology
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Summary:To investigate the accuracy of the 12-lead ECG in localizing the site of coronary artery narrowings, we reviewed abnormal ECGs obtained during myocardial infarction, spontaneous angina or exercise stress testing in 134 patients with angiographically documented one-vessel disease. The presence of Q waves, ST-segment elevation and T-wave inversion in leads I, aVL and V1--V4 were all highly correlated with the presence of left anterior descending coronary artery disease (p less than 0.001), and the same ECG findings in leads II, III and aVF were associated with right (RCA) or circumflex coronary artery (LCx) narrowings (p less than 0.001). In contrast, ST depression alone was not useful in predicting the site of coronary artery narrowing. Q waves correctly identified the location of the coronary disease in 98% of cases, ST elevation in 91%, T-wave inversion in 84%, and ST depression in 60%. No electrocardiographic criteria distinguished RCA from LCx disease, even in patients with a right-dominant circulation. These findings should lead to a better understanding of the value and limitations of the 12-lead ECG in localizing coronary artery disease.
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ISSN:0009-7322
1524-4539
DOI:10.1161/01.CIR.66.6.1168