title: [Usefulness of the electrocardiogram in predicting the occlusion site in acute anterior myocardial infarction with isolated disease of the left anterior descending coronary artery].
abstract: OBJECTIVE
  In acute anterior myocardial infarction (AMI), the site of occlusion in the left anterior descending coronary artery (LAD) is related to the extension of myocardial necrosis and the prognosis. The aim of this study was to assess the value of the electrocardiogram (ECG) as a predictor of the LAD occlusion site in patients with anterior AMI.
  
  
  METHODS
  Forty-five consecutive patients with a first anterior AMI and isolated disease of the LAD were included. We evaluated retrospectively the ECG with the most pronounced ST-segment changes before fibrinolysis and correlated the findings with the site of LAD occlusion in angiography before hospital discharge in relation to the first dominant septal and first diagonal branch: first septal affected (S), first diagonal affected (D), both affected (S + D), or neither affected were considered.
  
  
  RESULTS
  ST depression in leads II, III, or aVF strongly predicted proximal LAD occlusion in S + D, S, and D (p = 0,003, p = 0,04, and p = 0,02, respectively). ST elevation in leads II, III, or aVF was observed only in the presence of wrap-around LAD and was related with occlusion distal to the first diagonal branch. ST elevation > or = 3 mm in lead V1 was a specific predictor of occlusion proximal to first septal (S, p = 0,01). ST elevation in aVR was associated with proximal LAD occlusion in S + D and S (p = 0,03 and p = 0,03, respectively) and absence of coronary collateral circulation.
  
  
  CONCLUSIONS
  In anterior AMI and isolated LAD disease, the ECG can be useful in predicting the LAD occlusion site in relation to its major side branches.
authors.affiliation: Servicio de Cardiología. Hospital Universitario La Fe. Valencia. España. lmartinezd@meditex.es
authors.forename: Luis
authors.initials: L
authors.lastname: Martínez-Dolz
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Arnau
authors.forename: Luis
authors.initials: L
authors.lastname: Almenar
authors.forename: Joaquín
authors.initials: J
authors.lastname: Rueda
authors.forename: Ana
authors.initials: A
authors.lastname: Osa
authors.forename: Anastasio
authors.initials: A
authors.lastname: Quesada
authors.forename: Joaquín
authors.initials: J
authors.lastname: Osca
authors.forename: Esther
authors.initials: E
authors.lastname: Zorio
authors.forename: Miguel
authors.initials: M
authors.lastname: Palencia
authors.forename: Romualdo
authors.initials: R
authors.lastname: Cebolla
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016001:Confidence Intervals; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology* / Q000503:physiopathology; D003627:Data Interpretation, Statistical; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012737:Sex Factors; D013997:Time Factors