Identifying the culprit artery via 12‐lead electrocardiogram in inferior wall ST‐segment elevation myocardial infarction: A meta‐analysis

BACKGROUND: Inferior wall ST‐segment elevation myocardial infarction (STEMI) is mostly caused by acute occlusion of right coronary artery (RCA) and left circumflex artery (LCX). Several methods and algorithms using 12‐lead ECG were developed to localize the lesion in inferior wall STEMI. However, the diagnostic properties of these methods remain under‐recognized. AIMS: The aim of this meta‐analysis is to compare the diagnostic properties among the methods of identifying culprit artery in inferior wall STEMI using 12‐lead ECG. METHODS: We performed a meta‐analysis to calculate the pooled sensitive, specificity, area under the curve (AUC) and diagnostic odds ratio (DOR) of each method. RESULTS: Thirty‐three studies with 4414 participants were included in the analysis. Methods using double leads had better diagnostic properties, especially ST‐segment elevation (STE) in III > II [with pooled sensitivity 0.89 (0.84–0.93), specificity 0.68 (0.57–0.79), DOR 17 (9–32), AUC 0.88 (0.85–0.91)], ST‐segment depression (STD) in aVL > I [with pooled sensitivity 0.82 (0.72–0.90), specificity 0.69 (0.48–0.86), DOR 11 (4–29), AUC 0.85 (0.81–0.88)], and STD V3/STE III ≤1.2 [with pooled sensitivity 0.88 (0.78–0.95), specificity 0.59 (0.42–0.75), DOR 12 (5–27), AUC 0.82 (0.78–0.85)]. Diagnostic algorithms, including Jim score[pooled sensitivity 0.70 (0.55–0.85), specificity 0.88 (0.75–0.96)], Fiol's algorithm [pooled sensitivity 0.54 (0.44–0.62), specificity 0.92 (0.88–0.96)] and Tierala's algorithm [pooled sensitivity 0.60 (0.49–0.71), specificity 0.91 (0.86–0.96)], were not superior to these simple methods. CONCLUSIONS: Our meta‐analysis indicated that diagnostic methods using double leads had better properties. STE in III > II together with STD in aVL > I may be the most ideal method, for its accuracy and convenience.