Driver et al reported a formula for distinguishing variant ST segment elevation in V2 to V4 (early repolarization) from an occluded left anterior descending coronary artery. The authors are from Hennepin County Medical Center in Minneapolis, Abbott Northwestern Hospital, Advocate Lutheran General Hospital, and Aurora St. Luke's Medical Center.
Exclusions: obvious STEMI, ST elevation > 5 mm, Q-waves, positive troponin plus other criteria
Parameters:
(1) R-wave amplitude in lead V4 in mm
(2) ST segment elevation at 60 ms after the J-point in lead V3 in mm
(3) Bazett-corrected QT interval in milliseconds
(4) QRS amplitude in V2 in mm
Parameter
Points
R-wave amplitude in V4
-0.268 * (amplitude)
ST-segment elevation in V3
1.062*(ST elevation)
QTc
0.052 * (QTc)
QRS amplitude in V2
-0.151 * (amplitude)
score =
= SUM(points for all 4 parameters)
Interpretation:
• A score >= 18.2 is associated with left anterior descending artery occlusion.
• A lower score is seen with early repolarization.
Performance:
• The area under the ROC curve is 0.96.
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