Finding LCX AMI With Posterior ECG LeadS

Study Overview
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Brief Summary
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Along with symptoms of chest pain, the presence of ST segment elevations on ECG is the criterion usually used in practice to identify patients with acute coronary artery occlusion and is essential for the direct and acute referral of patients for primary PCI. However, ECG does not always reflect changes in the posterior wall of the heart, often equivalent to the left circumflex coronary artery's (LCX) supply area, resulting in an underrepresentation of LCX as culprit artery in STEMI populations. There is a general concern that some patients with genuine acute occlusion of LCX may present without ST segment elevation and be denied reperfusion therapy, resulting in larger infarction and worse outcome. The aim of this trial is to implement record of posterior ECG leads (V7, V8 and V9) in addition to the standard 12-lead ECG in the pre-hospital setting and to evaluate the clinical impact of this implementation: In comparison to a control cohort of STEMI patients diagnosed with a pre-hospital standard 12-lead ECG prior study start, the investigators hypothesize that introducing V7-V9 leads as a clinical routine in the pre-hospital setting will identify patients with STEMI involving LCX and with a non-diagnostic standard 12-lead ECG.

Official Title
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Clinical Impact of Pre-hospital Posterior ECG Leads Implementation for Identifying Occlusion of Left Circumflex Coronary Artery in ST Segment Elevation Myocardial Infarction

Conditions
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Myocardial Infarction

Intervention / Treatment
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* Other: Standard 12-Lead ECG
* Other: Posterior ECG Leads


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Intervention group: All STEMI patients referred directly from the pre-hospital setting, treated with primary PCI and with available standard 12-lead ECG and ECG with V7-V9 leads. Exclusion Criteria: STEMI patients treated with primary PCI and no ECG with V7-V9 leads.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Control<br> | Other: Standard 12-Lead ECG<br>* Conventional record of Standard 12-lead ECG in every patient with suspect of acute coronary syndrome.<br>|
| Intervention<br> | Other: Standard 12-Lead ECG<br>* Conventional record of Standard 12-lead ECG in every patient with suspect of acute coronary syndrome.<br>Other: Posterior ECG Leads<br>* Recording posterior ECG leads (V7, V8 and V9) in addition to standard 12-lead ECG for identifying STEMI involving left cirumflex coronary artery.<br>* Other names: Posterior Leads (V7, V8 and V9);|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of patients with LCX occlusion as culprit artery in the intervention group compared to the control group |  | Day one - culprit lesion treated with primary PCI | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of patients in the intervention group with STEMI involving LCX artery, non-diagnostic standard 12-lead ECG and ST segment elevation >0,5 mm in ≥2 leads in posterior ECG leads (V7-V9). |  | Day one - culprit lesion treated with primary PCI | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ST Elevation, LCX Artery