PMID- 21176636
OWN - NLM
STAT- MEDLINE
DCOM- 20111020
LR  - 20101223
IS  - 0253-3758 (Print)
IS  - 0253-3758 (Linking)
VI  - 38
IP  - 10
DP  - 2010 Oct
TI  - [Reasons for failed electrocardiographic identification of the infarct-related 
      artery in patients with ST-elevation acute myocardial infarction].
PG  - 914-7
AB  - OBJECTIVE: The infarct-related artery (IRA) could not always be identified by 
      electrocardiogram (ECG). In the present study, we attempted to explore the reason 
      for failed IRA identification by ECG based on the comparison between ECG records 
      and coronary angiographic findings. METHODS: All 18-lead ECG records were 
      compared with respective angiographic findings in 1024 consecutive patients with 
      ST elevation myocardial infarction (STEMI) between October 2004 and July 2009. 
      More than two continuous 18-lead ECG records were performed within 12 hours of 
      the symptom onset in all patients. Patients with previous myocardial infarction, 
      coronary artery bypass surgery, pacemaker implantation or ECG evidence of left 
      bundle branch block and angiography was performed more than 12 hours time from 
      symptom onset were excluded. RESULTS: Of all 1024 patients enrolled, the IRA were 
      correctly identified in 854 cases and identified wrong in 96 cases and could not 
      be identified in 74 cases by ECG. Of the failed identification in these 170 
      cases, IRA was left circumflex coronary artery in 76 (44.7%)cases, right coronary 
      artery in 66 (38.8%) cases, left anterior descending branch in 20 (11.8%) cases, 
      ramus medianus branch in 7 (4.1%) cases, and left main in 1(0.6%) case. 
      Double-vessel and triple-vessel diseases were recorded in 27(15.9%) patients and 
      47(27.6%) patients respectively. Early repolarization syndrome occurred in 8 
      (4.7%) patients, and dextrocardia in 1 patient (0.6%). Angiographic study showed 
      acute occlusion of a small branch in 6 (3.5%) patients. CONCLUSION: Coronary 
      collateral vessel can mislead judgments of the IRA by ECG. When the IRA can not 
      be determined by ECG, left circumflex coronary artery is most likely to be the 
      culprit vessel. Occasionally, early repolarization syndrome and anatomic 
      variation of the coronary artery or heart and a small branch occlusion could be 
      causes of misjudgments of IRA by ECG.
FAU - Zhang, Xiao-jiang
AU  - Zhang XJ
AD  - Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
FAU - Yan, Hong-bing
AU  - Yan HB
FAU - Zheng, Bin
AU  - Zheng B
FAU - Song, Li
AU  - Song L
FAU - Wang, Jian
AU  - Wang J
FAU - Chi, Yun-peng
AU  - Chi YP
LA  - chi
PT  - English Abstract
PT  - Journal Article
PL  - China
TA  - Zhonghua Xin Xue Guan Bing Za Zhi
JT  - Zhonghua xin xue guan bing za zhi
JID - 7910682
SB  - IM
MH  - Adult
MH  - Aged
MH  - Coronary Angiography
MH  - *Diagnostic Errors
MH  - *Electrocardiography
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*diagnosis
EDAT- 2010/12/24 06:00
MHDA- 2011/10/21 06:00
CRDT- 2010/12/24 06:00
PHST- 2010/12/24 06:00 [entrez]
PHST- 2010/12/24 06:00 [pubmed]
PHST- 2011/10/21 06:00 [medline]
PST - ppublish
SO  - Zhonghua Xin Xue Guan Bing Za Zhi. 2010 Oct;38(10):914-7.