Diagnostic flowchart to estimate the morphology of left descending artery lesions by initial electrocardiogram in ST‐elevation myocardial infarction

Abstract

Background ST‐segment deviations in an initial 12‐lead electrocardiogram provide anatomical information in ST‐elevation myocardial infarction (STEMI). A diagnostic flowchart was formulated to estimate the anatomical characteristics of a culprit left anterior descending artery (LAD). Methods The present study analyzed 252 STEMI patients whose culprit lesions were confirmed to be LAD as an observational study. LAD morphology, wrapped ( n = 26) or not ( n = 226), and the positional relationship to first diagonal branch ( n = 162 in proximal, n = 90 in distal lesions) were assessed. Their ST‐segment deviations and such anatomical characteristics were examined. Results Reciprocal ST depression in nonwrapped LAD was frequent in patients without diagonal branch flow (49.3%–18.8% in II, p < .01; 66.4%–36.3% in III, p < .01; 63.7%–30.0% in aVF, p < .01). ST elevation in inferior leads was the characteristics of wrapped LAD but was not the case in patients without diagonal flow (50%–0% in II, 60%–0% in III, and 60%–0% in aVF). ST elevation in lateral leads to the diagonal branch in nonwrapped LAD is more frequent for proximal than distal lesions (36.3% vs. 15.0% in I, p < .01; 50.7% vs. 16.3% in aVL, p < .01), but this was not observed for wrapped LAD (18.8% vs. 20.0% in I, p = .72; 31.3% vs. 10.0% in aVL, p = .21). Positive and negative predictive values for the diagnostic accuracy of suggested diagnostic flow based on the above results were 0.794 and 0.478, respectively. Conclusions Our suggested diagnostic flowchart provides enough diagnostic accuracy to estimate culprit morphology.

Abnormal Electrocardiogram in a Man Presenting With Dyspnea and Chest Pain

“…3, arrow) if reperfusion is delayed. 3 This case highlights that, in AMI, an ECG showing STE in the anterior and inferior leads with inferior Q waves should raise suspicion for VSR.…”

Open Access for the Annals of Noninvasive Electrocardiology

“…Other interesting papers include very up‐to‐date review on ECG characteristics in patients with heart failure and normal ejection fraction from UK (Nikolaidou et al, ) and comprehensive review paper on heart rate variability during endurance exercise from Germany (Gronwald & Hoos, ). Original papers worth attention include study on the association between metabolic syndrome and QRT angle from the United States, (Delhey, Jin, Thapa, & Delongchamp, ) paper on the association between morphology of left descendent coronary artery and ECG in ST‐elevation myocardial infarction from Japan (Fujii, Hasegawa, Nakamura, & Ikari, ), study on temporal changes of noninvasive electrocardiographic risk factors for sudden cardiac death (Xenogiannis et al ), and a paper on compound and heterozygous KCNQ1 mutations in LQTS from China ( Lin et al ).…”