The relationship of the changes in lateral leads I and aVL in electrocardiogram with echocardiography and coronary angiography findings in patients with acute coronary syndrome

BACKGROUND: Electrocardiographic (ECG) study is a principle for the symptoms contributed to the acute myocardial infarction (AMI)/acute coronary syndrome (ACS). The diagnosis of involved coronary artery based on ECG changes is still a challenge. This study is aimed to evaluate the association of mere changes in I and aVL leads with the involved region found through echocardiography and involved coronary artery through angiography.METHODS: This cross-sectional study was conducted on ۱۰۰ patients referred with AMI/ACS symptoms that had mere ECG changes in I and aVL leads (ST elevation + Q wave/ST depression + inverted-T). Transthoracic echocardiography (TTE) and coronary angiography (CAG) were performed for the patients. The correlation of ECG with echocardiography and angiography was assessed.RESULTS: Among the studied population, ۳۹ patients (۳۹%) were women with the mean ± standard deviation (SD) of age of ۶۴.۶۰ ± ۹.۳۹ years. There was no significant association between ECG changes in leads I and aVL with neither the stenosis of first diagonal (D۱) coronary artery found through angiography (P = ۰.۵۸۰) nor the mid-anterior wall dyskinesia found through echocardiography (P = ۰.۳۸۰). A remarkable association between the echocardiographic findings representing mid-anterior wall ischemic dyskinesia with the stenosis of D۱ coronary artery was detected (P < ۰.۰۰۱). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ۱۰۰%, ۵۴.۵۴%, ۹۴.۶۸%, and ۱۰۰% were respectively found as the diagnostic values of mentioned factors.CONCLUSION: Our findings showed significant association between D۱ involvement and mid-anterior dyskinesia in echocardiography, while the changes in ECG were associated neither with echocardiographic nor angiographic outcomes.