| Automated discrimination of proximal right coronary artery occlusion from middle-to-distal right coronary artery occlusion and left circumflex occlusion in ST-elevation myocardial infarction. | |
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MedLine Citation:
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PMID: 22912955 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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BACKGROUND: Classifying the location of an occlusion in the culprit artery during ST-elevation myocardial infarction (STEMI) is important for risk stratification to optimize treatment. We developed a new logistic regression (LR) algorithm for 3-group classification of occlusion location as proximal right coronary artery (RCA), middle-to-distal RCA or left circumflex (LCx) coronary artery with inferior myocardial infarction. We compared the performance of the new LR algorithm with the recently introduced decision tree classifier of Fiol et al (Ann Noninvasive Electrocardiol. 2004;4:383-388) in the classification of the same 3 categories. METHODS: The new algorithm was developed on a set of electrocardiograms from an emergency department setting (n = 64) and tested on a different set from a prehospital setting (n = 68). All patients met the current STEMI criteria with angiographic confirmation of culprit artery and occlusion location. Using LR, 4 ST-segment deviation features were chosen by forward stepwise selection. Final LR coefficients were obtained by averaging more than 200 bootstrap iterations on the training set. In addition, a separate 4-feature classifier was designed adding ST features of V4R and V8, only available in the training set. RESULTS: The LR algorithm classified proximal RCA occlusion vs combined LCx occlusion and middle-to-distal RCA occlusion, with a sensitivity of 76% and specificity of 81% as compared with 71% and 62% for the Fiol classifier. The difference in specificity was statistically significant. The LR classifier trained with additional ST features of V4R and V8, but still limited to 4, improved the overall agreement in the training set from 65% to 70%. CONCLUSION: Discrimination of proximal RCA lesion location from LCx or middle-to-distal RCA using the new LR classifier shows improvement over decision tree–type classification criteria. Automated identification of proximal RCA occlusion could speed up the risk stratification of patients with STEMI. The addition of leads V4R and V8 should further improve the automated classification of the occlusion site in RCA and LCx. |
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Authors:
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Richard E Gregg; Miquel Fiol-Sala; Kjell C Nikus; Ronald Startt-Selvester; Sophia H Zhou; Andrés Carrillo; Victoria Barbara; Cheng-hao Simon Chien; James M Lindauer |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of electrocardiology Volume: 45 ISSN: 1532-8430 ISO Abbreviation: J Electrocardiol Publication Date: 2012 Jul-Aug |
Date Detail:
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Created Date: 2012-08-21 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0153605 Medline TA: J Electrocardiol Country: United States |
Other Details:
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Languages: eng Pagination: 343-9 Citation Subset: IM |
Affiliation:
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Advanced Algorithm Research Center, Philips Healthcare, Thousand Oaks, CA, USA. rich.gregg@philips.com |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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