Relation of ST-segment changes in inferior leads during anterior wall acute myocardial infarction to length and occlusion site of the left anterior descending coronary artery

Sasaki, Kenji; Yotsukura, Masayuki; Sakata, Konomi; Yoshino, Hideaki; Ishikawa, Kinya

doi:10.1016/s0002-9149(01)01549-1

Cited by 86 publications

(82 citation statements)

References 21 publications

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“…In fact, Sasaki et al previously demonstrated that patients with wrapped left anterior descending artery had ST elevation in inferior leads more frequently than those without (16). As shown in Fig.…”

Section: Discussionmentioning

confidence: 85%

Acute Myocardial Infarction Associated with Myocardial Bridging in a Young Adult

et al. 2004

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A 28-year-old man was admitted because of chest pain. Emergency coronary angiography showed a massive thrombus in the proximal segment and another occlusive thrombus in the distal segment of the left anterior descending artery. He was treated with thrombolytic therapy. Repeat coronary angiography showed disappearance of the thrombi in the proximal and distal segments and obvious myocardial bridging in the mid segment. Intravascular ultrasound revealed an atherosclerotic plaque in the segment immediately proximal to the myocardial bridging, but did not reveal any plaque within or distal to the site. He was discharged 12 days later.

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Section: Discussionmentioning

confidence: 85%

Acute Myocardial Infarction Associated with Myocardial Bridging in a Young Adult

et al. 2004

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“…Usually, 2 conditions are thought to be necessary for these findings: relatively small mass of ischemic anterior wall myocardium, resulting in a weaker anterior injury current and less reciprocal inferior ST-segment depression, and a concomitant inferior wall transmural ischemia that further shifts the inferior ST segments upward. According to other studies, inferior ST-segment elevation was related to a distal LAD stenosis or a wrapped LAD artery [1,2].…”

Section: Discussionmentioning

confidence: 86%

“…Occlusion of the left anterior descending coronary artery (LAD) may cause infarction of the anterior wall of the left ventricle, manifested as precordial ST-segment elevations. Inferior ST-segment elevations due to occlusion of a LAD may reflect an ischemia of wrapped LAD artery [1,2]. We describe a patient with ST elevation in inferior leads and ST depression in precordial leads caused by acute occlusion at the proximal segment LAD with collateral flow from the left circumflex (LCx) coronary artery and RCA.…”

Section: Introductionmentioning

confidence: 97%

Acute myocardial infarction caused by left anterior descending artery occlusion presenting as inferior ST elevation and anterior ST depression

Honda

Fujimoto

Miyao

et al. 2014

Journal of Cardiology Cases

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a b s t r a c tWe report a case of acute myocardial infarction caused by left anterior descending artery occlusion presenting as ST elevation in the inferior leads and ST depression in the precordial leads, suggesting an involvement of the right coronary artery (RCA). However, coronary angiography (CAG) showed a complete occlusion of the proximal left anterior descending (LAD) coronary artery and collaterals from the left circumflex coronary artery and the RCA. Although he underwent primary percutaneous coronary intervention (PCI), he had chest pain at four days after primary PCI. His electrocardiogram (ECG) showed precordial ST elevation, suggesting an involvement of the LAD. Emergent CAG showed a complete occlusion of the proximal LAD without collaterals, but his ECG showed precordial ST elevation that was different from ST changes seen on admission. These unusual ST-segment changes might be associated with a weaker anterior ischemia due to collaterals and a strong inferior ischemia due to wrapped LAD artery.

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“…Previous studies showed that ST ↓ in inferior leads is a useful marker for identifying proximal LAD artery occlusion during MI [8,13,16,17]. This parameter has also been correlated with the severity of anterior wall ischemia [20][21].…”

Section: Discussionmentioning

confidence: 95%

“…Most studies have shown a poor correlation between the electrocardiogram (ECG) results and the exact extent of myocardial involvement as determined by autopsy [5,6]. In previous studies, proximal LAD artery lesion before branching S 1 (first septal branch) and/or D 1 (first diagonal branch) could be predicted by the 11 ECG parameters [7][8][9][10][11][12][13][14][15][16][17][18], namely, ST-segment depression (≥1.0 mm) in inferior leads, ST-segment elevation (≥1.0 mm) in lead aVL, ST-segment depression (≥1.0 mm) in lead aVL, ST-segment elevation (≥0.5 mm) in lead aVR, ST-segment elevation (≥2.5 mm) in lead V 1 , ST-segment elevation (<2.5 mm) in lead V 1 , STsegment elevation (≥1.0 mm) in lead V 2 , inverted U wave in lead V 1 to lead V 4 , ST-segment depression (≥1.0 mm) in lead V 5 , T inversion in lead V 4 and/or lead, and a Q wave in lead V 4 to lead V 6 . We decided to asses these ECG findings to predict whether significant lesions in the proximal LAD artery were present in patients with and without signs of anterior myocardial infarction (MI).…”

Section: Introductionmentioning

confidence: 99%

Electrocardiographic predictors of proximal left anterior descending coronary artery occlusion

et al. 2008

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AbstractProximal occlusion of the left anterior descending coronary artery (LAD) results in a less favorable prognosis in coronary angiography. Therefore, it is important to determine whether there are significant lesions in LAD by electrocardiography (ECG) before coronary angiography. Twelve-lead ECG was compared in 130 patients with significant lesions (≥70% stenosis) confined to proximal part of the LAD (P LAD group) and 492 patients with normal coronary angiography (control group). Fifty-nine patients in the P LAD group and 18 patients in the control group had signs of anterior myocardial infarction as shown by ST elevation (≥1.0 mV) in two consecutive pericardial leads or the presence of a pathological Q wave. An inverted U wave (biphasic T wave) in leads V1 to V4 had a sensitivity of 49.3% (35/71) in P LAD patients without signs of anterior myocardial infarction (MI) and 96.6 % (57/59; specificity, 66.6%; positive predictive value, 90.9 %) in the P LAD patients with signs of anterior MI. In the P LAD patients with signs of anterior MI, T inversion in V4–V5 had a lower sensitivity (67.0% [40/59]) than an inverted U wave. ST depression in inferior leads and ST depression in V5 were not useful markers of proximal LAD occlusion. In conclusions, an inverted U wave in V1 to V4 (or in each of these leads) and T inversion in V4–V5 are the best predictors of significant proximal LAD lesion, especially in patients with ECG findings of anterior MI.

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Relation of ST-segment changes in inferior leads during anterior wall acute myocardial infarction to length and occlusion site of the left anterior descending coronary artery

Cited by 86 publications

References 21 publications

Acute Myocardial Infarction Associated with Myocardial Bridging in a Young Adult

Acute Myocardial Infarction Associated with Myocardial Bridging in a Young Adult

Acute myocardial infarction caused by left anterior descending artery occlusion presenting as inferior ST elevation and anterior ST depression

Electrocardiographic predictors of proximal left anterior descending coronary artery occlusion

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