PMID- 10440150 OWN - NLM STAT- MEDLINE DCOM- 19990817 LR - 20220408 IS - 0735-1097 (Print) IS - 0735-1097 (Linking) VI - 34 IP - 2 DP - 1999 Aug TI - Value of the electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction. PG - 389-95 AB - 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 elevation(aVR)), complete right bundle branch block, ST-depression in lead V5 (ST depression(V5)) and ST elevation(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 depression(aVL) was suggestive of occlusion distal to D1 (p = 0.002 and p = 0.022, respectively). For both the S1 and D1, inferior ST depression > or = 1.0 mm strongly predicted proximal LAD occlusion, whereas absence of inferior ST depression predicted distal occlusion (p < or = 0.002 and p < or = 0.020, respectively). CONCLUSIONS: In anterior AMI, the ECG is useful to predict the LAD occlusion site in relation to its major side branches. FAU - Engelen, D J AU - Engelen DJ AD - Department of Cardiology, University Hospital Maastricht, Cardiovascular Research Institute, The Netherlands. D.Engelen@cardio.azm.nl FAU - Gorgels, A P AU - Gorgels AP FAU - Cheriex, E C AU - Cheriex EC FAU - De Muinck, E D AU - De Muinck ED FAU - Ophuis, A J AU - Ophuis AJ FAU - Dassen, W R AU - Dassen WR FAU - Vainer, J AU - Vainer J FAU - van Ommen, V G AU - van Ommen VG FAU - Wellens, H J AU - Wellens HJ LA - eng PT - Journal Article PL - United States TA - J Am Coll Cardiol JT - Journal of the American College of Cardiology JID - 8301365 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Arteries/pathology MH - Constriction, Pathologic MH - Coronary Angiography MH - Coronary Vessels/*pathology MH - *Electrocardiography MH - Female MH - Humans MH - Male MH - Middle Aged MH - Myocardial Infarction/diagnostic imaging/*pathology/physiopathology MH - Predictive Value of Tests EDAT- 1999/08/10 00:00 MHDA- 1999/08/10 00:01 CRDT- 1999/08/10 00:00 PHST- 1999/08/10 00:00 [pubmed] PHST- 1999/08/10 00:01 [medline] PHST- 1999/08/10 00:00 [entrez] AID - S0735109799001977 [pii] AID - 10.1016/s0735-1097(99)00197-7 [doi] PST - ppublish SO - J Am Coll Cardiol. 1999 Aug;34(2):389-95. doi: 10.1016/s0735-1097(99)00197-7.