|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 1988; 12:1156-1166 © 1988 by the American College of Cardiology Foundation |
Department of Internal Medicine, University of Virginia Medical Center, Charlottesville 22908.
Forty consecutive patients with creatine kinase-MB confirmed myocardial infarction due to circumflex artery occlusion (Group 1) were prospectively evaluated and compared with 107 patients with infarction due to right coronary artery occlusion (Group 2) and 94 with left anterior descending artery occlusion (Group 3). All 241 patients underwent exercise thallium-201 scintigraphy, radionuclide ventriculography, 24 h Holter electrocardiographic (ECG) monitoring and coronary arteriography before hospital discharge and were followed up for 39 +/- 18 months. There were no significant differences among the three infarct groups in age, gender, number of risk factors, prevalence and type of prior infarction, Norris index, Killip class and frequency of in-hospital complications. Acute ST segment elevation was present in only 48% of patients in Group 1 versus 71 and 72% in Groups 2 and 3, respectively (p = 0.012), and 38% of patients with a circumflex artery-related infarct had no significant ST changes (that is, elevation or depression) on admission (versus 21 and 20% for patients in Groups 2 and 3, respectively) (p = 0.001). Abnormal R waves in lead V1 were more common in Group 1 than in Group 2 (p less than 0.003) as was ST elevation in leads I, aVL and V4 to V6 (p less than or equal to 0.048). These differences in ECG findings between Group 1 and 2 patients correlated with a significantly higher prevalence of posterior and lateral wall asynergy in the group with a circumflex artery-related infarct. Infarct size based on peak creatine kinase levels and multiple radionuclide variables was intermediate in Group 1 compared with that in Group 2 (smallest) and Group 3 (largest). During long-term follow-up, the probability of recurrent cardiac events was similar in the three infarct groups. When patients with a circumflex artery-related infarct were stratified according to the presence or absence of abnormal R waves in lead V1 or V2, the abnormal R wave group had more admission ST elevation (p = 0.025), a larger infarct (p less than 0.05) and more extensive coronary artery disease (p = 0.027). In fact, all patients with a circumflex artery-related infarct and an abnormal R wave in lead V1 had multivessel disease. An abnormal R wave in lead V1 had a 96% specificity for circumflex versus right coronary artery-related infarction but a sensitivity of only 21%. Discriminate function analysis of all admission historical and ECG variables identified inferior and lateral ST elevation as independent predictors of circumflex artery-related infarction...
This article has been cited by other articles:
|
|
 |
|
  S. G. Goodman, V. Menon, C. P. Cannon, G. Steg, E. M. Ohman, and R. A. Harrington Acute ST-Segment Elevation Myocardial Infarction: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 708S - 775S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S.-F. Wung Discriminating Between Right Coronary Artery and Circumflex Artery Occlusion by Using a Noninvasive 18-Lead Electrocardiogram Am. J. Crit. Care., January 1, 2007; 16(1): 63 - 71. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Kurum, A. Birsin, G. Ozbay, and M. Ture Differentiating the Infarct-Related Artery on Initial Electrocardiogram in Single or Multi-Vessel Disease in Acute Inferior Myocardial Infarction and Evaluating Involvement of Vessels Using Correspondence Analysis Angiology, July 1, 2005; 56(4): 385 - 389. [Abstract] [PDF]
|
|
|
|
|
|
O. Bolca, M. Eren, O. Akdemir, A. Yildirim, B. Dagdeviren, and T. Tezel Prediction of Infarct-Related Coronary Artery of Patients with Acute Inferior Myocardial Infarction by a Predischarge Exercise Test Index Angiology, November 1, 2004; 55(6): 679 - 683. [Abstract] [PDF]
|
|
|
|
|
|
O. Bolca, M. Eren, O. Akdemir, A. Yildirim, B. Dagdeviren, and T. Tezel Prediction of Infarct-Related Coronary Artery of Patients with Acute Inferior Myocardial Infarction by a Predischarge Exercise Test Index Angiology, November 1, 2004; 55(6): 679 - 683. [Abstract] [PDF]
|
|
|
|
 |
|
 Y Birnbaum and B J Drew The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis Postgrad. Med. J., September 1, 2003; 79(935): 490 - 504. [Abstract] [Full Text]
|
|
|
|
|
|
C. Schmitt, G. Lehmann, S. Schmieder, M. Karch, F.-J. Neumann, and A. Schomig Diagnosis of Acute Myocardial Infarction in Angiographically Documented Occluded Infarct Vessel : Limitations of ST-Segment Elevation in Standard and Extended ECG Leads Chest, November 1, 2001; 120(5): 1540 - 1546. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Matetzky, D. Freimark, M. S. Feinberg, I. Novikov, S. Rath, B. Rabinowitz, E. Kaplinsky, and H. Hod Acute myocardial infarction with isolated ST-segment elevation in posterior chest leads V7-9: "hidden" ST-segment elevations revealing acute posterior infarction J. Am. Coll. Cardiol., September 1, 1999; 34(3): 748 - 753. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Muller-Bardorff, H. Freitag, T. Scheffold, A. Remppis, W. Kubler, and H. A. Katus Development and Characterization of a Rapid Assay for Bedside Determinations of Cardiac Troponin T Circulation, November 15, 1995; 92(10): 2869 - 2875. [Abstract] [Full Text]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
