Localizing Value of Anginal Pain to Coronary Artery Involvement in Patients with STEMI.

Introduction: It is usually considered that pain in acute coronary syndrome has no localising value to identify the coronary artery involved. A few studies have tried to correlate the location and radiation of pain to the occluded vessel with conflicting results. The present study was done to find out the relationship between the site and / or radiation of chest pain with culprit artery in acute ST elevation myocardial infarction (STEMI). Methods: Out of 469 patientsadmitted with STEMI for primary PCI, 274 patients were included. Exclusion criteria included patients with prior historyof coronary syndrome, patients with multivessel disease (>50% lesion in non-culprit vessels), unable to localise thesite and/or radiation of chest pain and unwillingness to give consent. Results: Majority of the patients (62.5%) withchest pain radiating to left arm were having LAD occlusion while the majority of the patients (57.1%) with chest painradiating to right arm were having RCA occlusion. Patients with chest pain radiating to neck and or jaw were havingstatistically significant higher occlusion of RCA (96.4%) with a p value of <0.05. Surprisingly, LAD involvement was notpresent even in single case in acute coronary syndrome patients presented with chest pain radiating to neck/jaw. Conclusion: The present study showed a very high positive predictive value (96.42%) of radiation of anginal pain toneck/jaw radiation for predicting the RCA occlusion in patients presenting with acute ST elevation MI. [ABSTRACT FROM AUTHOR]