Electrocardiographic evolution of posterior acute myocardial infarction: Importance of early precordial ST-segment depression

Boden, William E.; Kleiger, Robert E.; Gibson, Robert S.; Schwartz, David J.; Schechtman, Kenneth B.; Capone, Robert J.; Roberts, Robert

doi:10.1016/0002-9149(87)91091-5

Cited by 124 publications

(43 citation statements)

References 19 publications

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“…Acute fibrinolytic therapy is contraindicated for ACS patients without ST-segment elevation, except for those with electrocardiographic true posterior MI manifested as ST-segment depression in 2 contiguous anterior precordial leads and/or isolated ST-segment elevation in posterior chest lead. [32][33][34] Inverted T waves may also indicate UA/ NSTEMI. In patients suspected of having ACS on clinical grounds, marked (greater than or equal to 2 mm [0.2 mV]) symmetrical precordial T-wave inversion strongly suggests acute ischemia, particularly that associated with a critical stenosis of the left anterior descending coronary artery (LAD).…”

Section: Electrocardiogrammentioning

confidence: 99%

2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention

Feldman¹,

Hirshfeld²,

Kern³

et al. 2008

Circulation

703

157

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Section: Electrocardiogrammentioning

confidence: 99%

2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention

Feldman¹,

Hirshfeld²,

Kern³

et al. 2008

Circulation

703

157

View full text Add to dashboard Cite

“…16,26 It is possible that a significant proportion of the patients without STsegment elevation in lead aVR but with ST-segment depression in other leads, a subset with low complication rates despite having the highest CK-MB peak, had posterior infarctions. 27 In a recent study of patients with non-STsegment elevation acute coronary syndromes, those with the highest elevations of biochemical markers for myocardial necrosis frequently had an occlusion of the left circumflex artery and were at lower risk of suffering a reinfarction than those with intermediate elevations. 28 Several limitations must be acknowledged in relation to the present study.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Lead aVR in Patients With a First Non–ST-Segment Elevation Acute Myocardial Infarction

et al. 2003

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Background-ST-segment elevation in lead aVR has been associated with severe coronary artery lesions in patients with acute coronary syndromes, but the prognostic significance of this finding is unknown. Methods and Results-We analyzed the initial ECG in 775 consecutive patients admitted to our center with a first acute myocardial infarction without ST-segment elevation in leads other than aVR or V 1 . The rates of in-hospital death in patients without (nϭ525) and with 0.05 to 0.1 mV (nϭ116) or Ն0.1 mV (nϭ134) of ST-segment elevation in lead aVR were 1.3%, 8.6%, and 19.4%, respectively (PϽ0.001). After adjustment for the baseline clinical predictors and for ST-segment depression on admission, the odds ratios for death in the last 2 groups were, respectively, 4.2 (95% CI, 1.5 to 12.2) and 6.6 (95% CI, 2.5 to 17.6). The rates of recurrent ischemic events and heart failure during hospital stay also increased in a stepwise fashion among the groups, whereas creatine kinase-MB levels were similar. Among the 437 patients that were catheterized within 6 months, the prevalence of left main or 3-vessel coronary artery disease in the 3 groups was 22.0%, 42.6%, and 66.3%, respectively (PϽ0.001). Conclusions-Lead aVR contains important short-term prognostic information in patients with a first non-ST-segment elevation acute myocardial infarction. Because the poorer outcome predicted by ST-segment elevation in lead aVR seems to be related to a more severe coronary artery disease, an early invasive approach might be especially beneficial in patients presenting with this finding.

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“…Electrocardiogram during left circumflex artery or right coronary artery occlusion ST depression in leads V1-V4 is the most frequent electrocardiographic rinding in patients with an acute myocardial infarction due to a left circumflex artery occlusion (3)(4)(5).…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic Diagnosis of Left Circumflex Artery Occlusion and the Occlusion Site.

et al. 1996

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In patients with a posteroinferior acute myocardial infarction and both ST depression (in lead VI or V2) and ST elevation in the inferior leads, it is difficult to differentiate a left circumflex artery occlusion from a right coronary artery occlusion. Furthermore, there is no useful method to identify the obstruction site in the left circumflex artery. In a study of52 patients with single-vessel left circumflex artery disease, ST elevation in V6 was found to be a useful indicator for left circumflex artery occlusion in such patients. Furthermore, the sum of the ST changes in leads aVF and V2 is useful for identifying the occluded site in the left circumflex artery. (Internal Medicine 35: 261-265, 1996)

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Electrocardiographic evolution of posterior acute myocardial infarction: Importance of early precordial ST-segment depression

Cited by 124 publications

References 19 publications

2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention

2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention

Prognostic Value of Lead aVR in Patients With a First Non–ST-Segment Elevation Acute Myocardial Infarction

Electrocardiographic Diagnosis of Left Circumflex Artery Occlusion and the Occlusion Site.

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