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 (ST1aVR), complete right bundle branch block, ST-depression in
lead V5 (ST2V5) and ST1V1 Ͼ2.5 mm strongly predicted LAD occlusion proximal to S1,
whereas abnormal Q-waves in V4 – 6 were associated with occlusion distal to S1 (p ϭ 0.000,
p Ï­ 0.004, p Ï­ 0.009, p Ï­ 0.011 and p Ï­ 0.031 to 0.005, respectively). Abnormal Q-wave
in lead aVL was associated with occlusion proximal to D1, whereas ST2aVL was suggestive
of occlusion distal to D1 (p Ï­ 0.002 and p Ï­ 0.022, respectively). For both the S1 and D1,
inferior ST2 Õ†1.0 mm strongly predicted proximal LAD occlusion, whereas absence of
inferior ST2 predicted distal occlusion (p Õ… 0.002 and p Õ… 0.020, respectively).
CONCLUSIONS In anterior AMI, the ECG is useful to predict the LAD occlusion site in relation to its major
side branches