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Is the inferior ST-segment elevation in anterior myocardial infarction reliable in prediction of wrap-around left anterior descending artery occlusion? [Anatol J Cardiol]
Anatol J Cardiol. Ahead of Print: AJC-09465 | DOI: 10.14744/AnatolJCardiol.2019.09465  

Is the inferior ST-segment elevation in anterior myocardial infarction reliable in prediction of wrap-around left anterior descending artery occlusion?

Emrah Bozbeyoğlu1, Özlem Yıldırımtürk1, Emre Aslanger2, Barış Şimşek1, Can Yucel Karabay1, Olcay Özveren2, Muzaffer Murat Değertekin2
1Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital; İstanbul-Turkey
2Department of Cardiology, Yeditepe University Hospital; İstanbul-Turkey

Objective: In a subgroup of patients with the anterior wall myocardial infarction (MI), the electrocardiogram (ECG) records a concomitant inferior ST-segment elevation (STE), which is generally explained by a “wrap-around” left anterior descending (LAD) artery occlusion. However,
recent evidence indicates that this may be due to a distal LAD occlusion, which may be irrelevant to the LAD length. We investigated the relationship between inferior ST-T changes in anterior MI and the presence of a wrap-around LAD.
Methods: Consecutive patients diagnosed with anterior MI due to an acute LAD occlusion were enrolled into the study. All ECGs were measured manually by a cardiologist, who was blinded to the angiographic outcomes. The site of the LAD occlusion was determined using multiple angiographic views. A wrap-around LAD was defined as a LAD artery from a post-reperfusion coronary angiogram that perfused at least one-fourth of the inferior wall of the left ventricle in the right anterior oblique projection.
Results: A total of 379 anterior MI cases were enrolled, and the final study population consisted of 259 patients. The presence of a wrap-around LAD was more frequent in patients presenting with inferior STE compared with patients without inferior STE (62.1% vs. 30.4%, p=0.001), however, this relationship was weak (φ=0.211). Inferior STE was more frequent in distal occlusions (22.9% vs. 4.3%, p<0.001), which showed a stronger relationship (φ=0.285). The polarity of the T-wave in lead III did not give any clues about the LAD anatomy.
Conclusion: Contrary to the popular acceptance, our results indicate that a wrap-around LAD cannot be reliably diagnosed by ECG.

Keywords: coronary occlusion, electrocardiogram, myocardial infarction, ST segment elevation, wraparound




Corresponding Author: Emre Aslanger, Türkiye


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