Comparing new ECG algorithms to determine culprit artery location in acute inferior myocardial infarction

Background Early identification of the culprit coronary artery is essential for appropriate reperfusion therapy, as acute inferior ST-elevation myocardial infarction (STEMI) is frequently caused by occlusion of the right coronary artery or left circumflex artery. Aim This investigation assesses the precision of three ECG algorithms in identifying the culprit artery in acute inferior STEMI. Patients and methods A prospective cohort study was conducted on 300 acute inferior STEMI cases. Patients were diagnosed based on clinical presentation, ECG, and cardiac biomarkers. Three ECG algorithms were assessed with coronary angiographs as the reference standard. Coronary angiography classified patients into two groups based on the site of the culprit lesion: 216 right coronary artery lesions and 84 left circumflex artery lesions. Results Algorithm 1 demonstrated the highest accuracy (84.3%) in identifying the culprit artery, with 92.6% positive predictive value and 66.4% negative predictive value. Algorithm 2 showed an accuracy of 74.0%, and Algorithm 3 had the lowest accuracy at 57.6%. Agreement analysis revealed a kappa value of 0.610 for Algorithm 1, indicating substantial agreement, compared with 0.399 for Algorithm 2 (moderate) and 0.130 for Algorithm 3 (slight). Conclusions Algorithm 1 proved to be the most effective, offering the highest accuracy and reliability in guiding clinical decision-making and optimizing reperfusion therapy to improve patient outcomes.