title: Value of the electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Cardiology, University Hospital Maastricht, Cardiovascular Research Institute, The Netherlands. D.Engelen@cardio.azm.nl
authors.forename: D J
authors.initials: DJ
authors.lastname: Engelen
authors.forename: A P
authors.initials: AP
authors.lastname: Gorgels
authors.forename: E C
authors.initials: EC
authors.lastname: Cheriex
authors.forename: E D
authors.initials: ED
authors.lastname: De Muinck
authors.forename: A J
authors.initials: AJ
authors.lastname: Ophuis
authors.forename: W R
authors.initials: WR
authors.lastname: Dassen
authors.forename: J
authors.initials: J
authors.lastname: Vainer
authors.forename: V G
authors.initials: VG
authors.lastname: van Ommen
authors.forename: H J
authors.initials: HJ
authors.lastname: Wellens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000473:pathology; D003251:Constriction, Pathologic; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D011237:Predictive Value of Tests