New ECG Algorithm for the Prediction of Culprit Vessel in Acute Myocardial Infarction Involving Lateral Part of the Ventricle: Ilkay Classification

Figures & data

Table 1 Demographic, Electrocardiographic, and Angiographic Features of the Study Population

		Count	Column N %
Gender	Female	21	28.4%
	Male	53	71.6%
Study population	D1	7	9.5%
	D2	7	9.5%
	Cx- OM1/ RI	60	81.1%
Presence of Diagonal or Cx/OM1/RI	DIAGONAL (D1-D2)	(7+7) 14	18.9%
	(Cx/OM1 and RI)	(54+ 6) 60	81.1%
Successful PCI	Yes	74	100.0%
	No	0	0.0%
dm	No	62	83.8%
	Yes	12	16.2%
ht	No	64	86.5%
	Yes	10	13.5%
ST elevation in lead V2	Yes	14	18.9%
	No	60	81.1%
ST depression in lead V2	Yes	60	81.1%
	No	14	18.9%
High T wave (≥10 mm) in lead V2	Yes	7	9.5%
	No	67	90.5%
ST depression in lead III	Yes	14	18.9%
	No	60	81.1%

Abbreviations: Cx, left circumflex artery; OM1, first obtuse marginal artery; D1, first diagonal artery; D2, second diagonal artery; RI, ramus intermedius artery; PCI, primary percutaneous coronary intervention; DM, diabetes mellitus; HT, hypertension.

Table 2 The Relationship Between Electrocardiographic and Angiographic Regions of the Study Population

		Diagonal Group		Cx-OM1/RI Group		P
		f	%	f	%
dm	No	12	85.7%	50	83.3%	0.595
	Available	2	14.3%	10	16.7%
ht	No	11	78.6%	53	88.3%	0.388
	Available	3	21.4%	7	11.7%
ST elevation in lead V2	Available	14	100.0%	0	0.0%	<0.001
	No	0	0.0%	60	100.0%
ST depression in lead V2	Available	0	0.0%	60	100.0%	<0.001
	No	14	100.0%	0	0.0%
High T wave (≥10 mm) in lead V2	Available (D1 branch)	7	50.0%	0	0.0%	<0.001
	No (D2 branch)	7	50.0%	60	100.0%
ST depression in lead III	Available	14	100.0%	0	0.0%	<0.001
	No	0	0.0%	60	100.0%

Abbreviations: CX, left circumflex; OM1, first obtuse marginal; D1, first diagonal artery; D2, second diagonal artery; RI, ramus intermedius; DM, diabetes mellitus; HT, hypertension.

Figure 1 ECG pattern of patient with large diagonal branch (D1) occlusion. ≥10mm T wave and ST elevation in lead V2; ST elevation lead I and aVL; and ≥2 mm ST depression lead III.

Figure 2 ECG pattern of patient with small diagonal branch (D2) occlusion. Normal T wave and ST elevation in lead V2; minimal ST elevation in lead I and aVL, and <2 mm ST depression lead III.

Table 3 Electrocardiographic Algorithm of Lateral Myocardial Infarction as Ilkay Classification

Lateral Region	ST Elevation in Lead V2	Tall T Wave (≥10 mm)	ST Depression in Lead V2	ST Depression in Lead III
Large diagonal/ first diagonal (D1)	Yes	Yes	No	Yes
Small diagonal/second diagonal (D2)	Yes	No	No	Yes
Cx/OM1/ramus intermedius	No	No	Yes	No

Abbreviations: CX, left circumflex; OM1, first obtuse marginal; D1, first diagonal artery; D2, second diagonal artery; RI, ramus intermedius.

Figure 3 Isolated lateral wall myocardial infarction according to diagonal branches (D1 or D2) and the obtuse marginal has not been clearly identified as electrocardiographic classification. Therefore, there is a need for a new electrocardiogram (ECG) interpretation to accurately predict acute occlusion involving lateral part of ventricle.