Validation of contemporary electrocardiographic indices of area at risk and infarct size in acute ST elevation myocardial infarction (STEMI)

Yang Timothy Du, Sivabaskari Pasupathy, Tracy Air, Christopher Neil, John F. Beltrame

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

Background: Electrocardiographic (ECG) methods to assess area at risk (AAR) and infarct size (IS) in patients with ST-elevation myocardial infarction (STEMI) have been previously established but not validated against contemporary benchmark Cardiac Magnetic Resonance (CMR) measures. We compared ECG-determined and CMR-determined measures for (a) AAR, (b) IS, and (c) myocardial salvage. 

Methods: Sixty patients with ECG evidence of STEMI and CMR imaging performed within 13 days were included. The ECG-determined (a) AAR scores (Aldrich and Wilkins), (b) IS (Selvester score), and (c) myocardial salvage (i.e. [AAR-IS] / AAR × 100%), were compared with CMR-determined measures. 

Results: Compared with CMR-determined AAR, both the Wilkins & Aldrich scores underestimated AAR, although the Wilkins (r = 0.72, p < 0.001) showed a better correlation than the Aldrich (r = 0.54, p < 0.001). Bland-Altman analysis revealed a bias of 2.6% (95% limits of agreement: 18.5%, −13.3%) for the Wilkins and 5.9% (95% limits of agreement: 25.6%, −13.8%) for the Aldrich. Estimation of IS was similar between the Selvester score and CMR, with good correlation (r = 0.77, p < 0.001) and agreement (fixed bias 0.4%, 95% limits of agreement 20.8%, −15.5%). However, ECG-determined myocardial salvage significantly underestimated CMR-determined myocardial salvage, with an inverse correlation (r = −0.33, p = 0.01). 

Conclusions: The Wilkins score is superior to Aldrich score as an ECG-AAR index, Selvester score is a reasonable ECG estimate of infarct size, though ECG derived myocardial salvage does not have enough accuracy to be used in the clinical setting; it may be an inexpensive surrogate for myocardial salvage in large research studies. Further validation and prognostic studies are required.

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalInternational Journal of Cardiology
Volume303
Early online date13 Nov 2019
DOIs
Publication statusPublished - 15 Mar 2020
Externally publishedYes

Keywords

  • Electrocardiography
  • ST elevation acute myocardial infarction (STEMI)
  • Wilkins score
  • Aldrich score
  • Sylvester score

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