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ACC/AHA 2008 Performance Measures for Adults With ST-Elevation and Non-ST-Elevation Myocardial Infarction

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease
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J Am Coll Cardiol, 1999; 34:389-395
© 1999 by the American College of Cardiology Foundation
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CLINICAL STUDIES

Value of the electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction

Domien J. Engelen, MDa, Anton P. Gorgels, MDa, Emile C. Cheriex, MDa, Ebo D. De Muinck, MDa, Anton J. Oude Ophuis, MD*, Willem R. Dassen, PhDa, Jindra Vainer, MDa, Vincent G. van Ommen, MDa and Hein J. Wellens, MD, FACCa

a Department of Cardiology, University Hospital Maastricht, Cardiovascular Research Institute, Maastricht, The Netherlands
* Department of Cardiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

Manuscript received October 21, 1998; revised manuscript received March 4, 1999, accepted April 9, 1999.

Reprint requests and correspondence: Domien J.M. Engelen, Department of Cardiology, University Hospital Maastricht, Box 5800, 6202 AZ, Maastricht, The Netherlands
D.Engelen{at}cardio.azm.nl

OBJECTIVES

The study assessed the value of the electrocardiogram (ECG) as predictor of the left anterior descending coronary artery (LAD) occlusion site in relation to the first septal perforator (S1) and/or the first diagonal branch (D1) in patients with acute anterior myocardial infarction (AMI).

BACKGROUND

In anterior AMI, determination of the exact site of LAD occlusion is important because the more proximal the occlusion the less favorable the prognosis.

METHODS

One hundred patients with a first anterior AMI were included. The ECG showing the most pronounced ST-segment deviation before initiation of reperfusion therapy was evaluated and correlated with the exact LAD occlusion site as determined by coronary angiography.

RESULTS

ST-elevation in lead aVR (ST{uparrow}aVR), complete right bundle branch block, ST-depression in lead V5 (ST{downarrow}V5) and ST{uparrow}V1 >2.5 mm strongly predicted LAD occlusion proximal to S1, whereas abnormal Q-waves in V4–6 were associated with occlusion distal to S1 (p = 0.000, p = 0.004, p = 0.009, p = 0.011 and p = 0.031 to 0.005, respectively). Abnormal Q-wave in lead aVL was associated with occlusion proximal to D1, whereas ST{downarrow}aVL was suggestive of occlusion distal to D1 (p = 0.002 and p = 0.022, respectively). For both the S1 and D1, inferior ST{downarrow} ≥1.0 mm strongly predicted proximal LAD occlusion, whereas absence of inferior ST{downarrow} predicted distal occlusion (p ≤ 0.002 and p ≤ 0.020, respectively).

CONCLUSIONS

In anterior AMI, the ECG is useful to predict the LAD occlusion site in relation to its major side branches.

Abbreviations and Acronyms
  AMI = acute myocardial infarction
  cRBBB = complete right bundle branch block
  D1 = first diagonal branch
  ECG = electrocardiogram
  LAD = left anterior descending coronary artery
  Qx = abnormal Q-wave in lead x
  ST{uparrow} = ST-segment elevation
  ST{downarrow} = ST-segment depression
  ST{uparrow}x = ST-segment elevation in lead x
  ST{downarrow}x = ST-segment depression in lead x
  S1 = first septal perforator




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