Regional Wall Motion Abnormality as an Adjunct for Cardiac Catheterization Laboratory Activation in ST-Segment Elevation Myocardial Infarction

This is a cohort, longitudinal, observational study of the ability of EM-performed POCUS to reliably detect RWMA, and if so, correctly predict the culprit lesion (defined as >70% occlusion found via the gold standard of PCI). STEMI activations in patients older than 18 were enrolled if POCUS could be obtained prior to PCI. When the cardiac catheterization team was activated, an on-shift ultrasound-certified attending or resident performed a cardiac POCUS, then documented where, if any, regional wall motion abnormalities exist: Left Anterior Descending (LAD), Right Coronary Artery (RCA), or Left Circumflex Territory (LCX).

Over 600,000 people die of heart disease in the United States every year, accounting for one in every four deaths. In the emergency setting, an electrocardiogram (ECG) is used as the gold standard for activation of the cardiac catheterization team by identification of an ST Elevation Myocardial Infarction (STEMI); but in the emergent setting, the ECG can miss Occlusion Myocardial Infarctions (OMI) or have false positives. We hypothesize that detection of a Regional Wall Motion Abnormality (RWMA) on Point of Care Ultrasound (POCUS) can lead to improved detection of “culprit” lesions and prompter triage to Percutaneous Coronary Intervention (PCI).

From January 2023 to July 2025, 51 patients with STEMI on ECG were enrolled in the study. The point estimate of sensitivity for POCUS correct identification of culprit lesions were as follows: LAD 53.8%, RCA 50%, LCX 30.8%. Specificities: LAD 76.2%, RCA 66.7%, LCX 90%. The sensitivity to detect any culprit lesion was 82.1%, with a positive predictive value of 95.8%.

POCUS is an important adjunct in the management of STEMI, and the presence of a RWMA has a high likelihood of predicting a clinically significant coronary artery occlusion. The absence of RWMA cannot exclude a culprit lesion and is only moderately accurate at correctly identifying the correct culprit artery. Further studies should evaluate the predictive value of RWMA in detecting culprit lesions in suspected OMI, or use technology like speckle tracking to improve sensitivity.