This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Engelen, D. J. Articles by Wellens, H. J. Search for Related Content PubMed PubMed Citation Articles by Engelen, D. J. Articles by Wellens, H. J.

CLINICAL STUDIES

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

^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_aVR), complete right bundle branch block, ST-depression in lead V5 (ST_V5) and ST_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_aVL was suggestive of occlusion distal to D1 (p = 0.002 and p = 0.022, respectively). For both the S1 and D1, inferior ST 1.0 mm strongly predicted proximal LAD occlusion, whereas absence of inferior ST 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 = ST-segment elevation   ST = ST-segment depression   STx = ST-segment elevation in lead x   STx = ST-segment depression in lead x   S1 = first septal perforator

This article has been cited by other articles:

				G. S. Wagner, P. Macfarlane, H. Wellens, M. Josephson, A. Gorgels, D. M. Mirvis, O. Pahlm, B. Surawicz, P. Kligfield, R. Childers, et al. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram: Part VI: Acute Ischemia/Infarction A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology J. Am. Coll. Cardiol., March 17, 2009; 53(11): 1003 - 1011. [Full Text] [PDF]

				G. S. Wagner, P. Macfarlane, H. Wellens, M. Josephson, A. Gorgels, D. M. Mirvis, O. Pahlm, B. Surawicz, P. Kligfield, R. Childers, et al. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram: Part VI: Acute Ischemia/Infarction: A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: Endorsed by the International Society for Computerized Electrocardiology Circulation, March 17, 2009; 119(10): e262 - e270. [Full Text] [PDF]

				R. J. de Winter, N. J.W. Verouden, H. J.J. Wellens, A. A.M. Wilde, o. t. A. M. Center, and the Interventional Cardiology Group A New ECG Sign of Proximal LAD Occlusion N. Engl. J. Med., November 6, 2008; 359(19): 2071 - 2073. [Full Text] [PDF]

				K. Thygesen, J. S. Alpert, H. D. White, and on behalf of the Joint ESC/ACCF/AHA/WHF Task Force Universal Definition of Myocardial Infarction J. Am. Coll. Cardiol., November 27, 2007; 50(22): 2173 - 2195. [Full Text] [PDF]

				K. Thygesen, J. S. Alpert, H. D. White, on behalf of the Joint ESC/ACCF/AHA/WHF Task Force, TASK FORCE MEMBERS: Chairpersons: Kristian Thygese, Biomarker Group: Allan S. Jaffe, Coordinator (USA), ECG Group: Bernard Chaitman, Co-ordinator (USA), P, Imaging Group: Richard Underwood, Coordinator (UK), Intervention Group: Jean-Pierre Bassand, Co-ordina, Clinical Investigation Group: Paul W. Armstrong, C, et al. Universal Definition of Myocardial Infarction Circulation, November 27, 2007; 116(22): 2634 - 2653. [Full Text] [PDF]

				Task Force Members, K. Thygesen, J. S. Alpert, H. D. White, Biomarker Group, A. S. Jaffe, F. S. Apple, M. Galvani, H. A. Katus, L. K. Newby, et al. Universal definition of myocardial infarction: Kristian Thygesen, Joseph S. Alpert and Harvey D. White on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction Eur. Heart J., October 2, 2007; 28(20): 2525 - 2538. [Full Text] [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]

				J. A. Barrabes, J. Figueras, C. Moure, J. Cortadellas, and J. Soler-Soler Prognostic Value of Lead aVR in Patients With a First Non-ST-Segment Elevation Acute Myocardial Infarction Circulation, August 19, 2003; 108(7): 814 - 819. [Abstract] [Full Text] [PDF]

				P. J. Zimetbaum and M. E. Josephson Use of the Electrocardiogram in Acute Myocardial Infarction N. Engl. J. Med., March 6, 2003; 348(10): 933 - 940. [Full Text] [PDF]

				S. Kusachi, K. Iwasaki, and H. Yamaji Reply J. Am. Coll. Cardiol., August 7, 2002; 40(3): 576 - 577. [Full Text] [PDF]

				R. Nair and D. L. Glancy ECG Discrimination Between Right and Left Circumflex Coronary Arterial Occlusion in Patients With Acute Inferior Myocardial Infarction* : Value of Old Criteria and Use of Lead aVR Chest, July 1, 2002; 122(1): 134 - 139. [Abstract] [Full Text] [PDF]

				H. Yamaji, K. Iwasaki, S. Kusachi, T. Murakami, R. Hirami, H. Hamamoto, K. Hina, T. Kita, N. Sakakibara, and T. Tsuji Prediction of acute left main coronary artery obstruction by 12-lead electrocardiography: ST segment elevation in lead aVR with less ST segment elevation in lead V1 J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1348 - 1354. [Abstract] [Full Text] [PDF]

				A. P. M. Gorgels, D. J. M. Engelen, and H. J. J. Wellens Lead aVR, a mostly ignored but very valuable lead in clinical electrocardiography J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1355 - 1356. [Full Text] [PDF]