Journal of Electrocardiology
Volume 42, Issue 2 , Pages 120-127 , March 2009

Predicting the culprit artery in acute ST-elevation myocardial infarction and introducing a new algorithm to predict infarct-related artery in inferior ST-elevation myocardial infarction: correlation with coronary anatomy in the HAAMU Trial

  • Ilkka Tierala, MD

      Affiliations

    • Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
    • Corresponding Author InformationCorresponding author. Tel.: +358 3 31164141; fax: +358 3 31164157.
    • Authors Tierala and Nikus have contributed equally to the manuscript.
  • ,
  • Kjell C. Nikus, MD

      Affiliations

    • Department of Cardiology, Heart Center, Tampere University Hospital, Tampere, Finland
    • Authors Tierala and Nikus have contributed equally to the manuscript.
  • ,
  • Samuel Sclarovsky, MD

      Affiliations

    • Procardia Medical Center, Tel Aviv, Israel
  • ,
  • Mikko Syvänne, MD

      Affiliations

    • Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
  • ,
  • Markku Eskola, MD

      Affiliations

    • Department of Cardiology, Heart Center, Tampere University Hospital, Tampere, Finland
  • ,
  • the HAAMU Study Group

Received 2 November 2008

References 

  1. Sclarovsky S. Electrocardiography of acute myocardial ischaemic syndromes. London, UK: Martin Dunitz Ltd.; 1999;
  2. Birnbaum Y, Drew BJ. The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis. Postgrad Med J. 2003;79:490
  3. Zimetbaum PJ, Josephson ME. Use of the electrocardiogram in acute myocardial infarction. N Engl J Med. 2003;348:933
  4. Eskola MJ, Holmvang L, Nikus KC, et al. The electrocardiogram window of opportunity to treat vs. the different evolving stages of ST-elevation myocardial infarction: correlation with therapeutic approach, coronary anatomy, and outcome in the DANAMI-2 trial. Eur Heart J. 2007;29:2485
  5. Eskola MJ, Nikus KC, Holmvang L, et al. Value of the 12-lead electrocardiogram to define the level of obstruction in acute anterior wall myocardial infarction: correlation to coronary angiography and clinical outcome in the DANAMI-2 trial. Int J Cardiol. 2008;[Epub ahead of print]
  6. Eskola MJ, Nikus KC, Niemela KO, Sclarovsky S. How to use ECG for decision support in the catheterization laboratory. Cases with inferior ST elevation myocardial infarction. J Electrocardiol. 2004;37:257
  7. Nikus KC, Eskola MJ, Niemela KO, Sclarovsky S. Modern morphologic electrocardiographic interpretation—a valuable tool for rapid clinical decision making in acute ischemic coronary syndromes. J Electrocardiol. 2005;38:4
  8. Kosuge M, Kimura K, Ishikawa T, et al. New electrocardiographic criteria for predicting the site of coronary artery occlusion in inferior wall acute myocardial infarction. Am J Cardiol. 1998;82:1318
  9. Chia BL, Yip JW, Tan HC, Lim YT. Usefulness of ST elevation II/III ratio and ST deviation in lead I for identifying the culprit artery in inferior wall acute myocardial infarction. Am J Cardiol. 2000;86:341
  10. Herz I, Assali AR, Adler Y, Solodky A, Sclarovsky S. New electrocardiographic criteria for predicting either the right or left circumflex artery as the culprit coronary artery in inferior wall acute myocardial infarction. Am J Cardiol. 1997;80:1343
  11. Zimetbaum PJ, Krishnan S, Gold A, Carrozza JP, Josephson ME. Usefulness of ST-segment elevation in lead III exceeding that of lead II for identifying the location of the totally occluded coronary artery in inferior wall myocardial infarction. Am J Cardiol. 1998;81:918
  12. Bairey CN, Shah PK, Lew AS, Hulse S. Electrocardiographic differentiation of occlusion of the left circumflex versus the right coronary artery as a cause of inferior acute myocardial infarction. Am J Cardiol. 1987;60:456
  13. Gupta A, Lokhandwala YY, Kerkar PG, Vora AM. Electrocardiographic differentiation between right coronary and left circumflex coronary arterial occlusion in isolated inferior wall myocardial infarction. Indian Heart J. 1999;51:281
  14. Assali AR, Herz I, Vaturi M, et al. Electrocardiographic criteria for predicting the culprit artery in inferior wall acute myocardial infarction. Am J Cardiol. 1999;84:87
  15. Fiol M, Cygankiewicz I, Carrillo A, et al. Value of electrocardiographic algorithm based on “ups and downs” of ST in assessment of a culprit artery in evolving inferior wall acute myocardial infarction. Am J Cardiol. 2004;94:709
  16. Tierala I. Comparison of prehospital thrombolysis and primary percutaneous coronary intervention in ST-elevation acute myocardial infarction. (abstract) Am J Cardiol. 2005;96:64H
  17. Braat SH, de Zwaan C, Brugada P, Coenegracht JM, Wellens HJ. Right ventricular involvement with acute inferior wall myocardial infarction identifies high risk of developing atrioventricular nodal conduction disturbances. Am Heart J. 1984;107:1183
  18. Berger PB, Ryan TJ. Inferior myocardial infarction. High-risk subgroups. Circulation. 1990;81:401
  19. Wellens HJ. The value of the right precordial leads of the electrocardiogram. N Engl J Med. 1999;340:381
  20. Erhardt LR, Sjogren A, Wahlberg I. Single right-sided precordial lead in the diagnosis of right ventricular involvement in inferior myocardial infarction. Am Heart J. 1976;91:571
  21. Chou TC, Van der Bel-Kahn J, Allen J, Brockmeier L, Fowler NO. Electrocardiographic diagnosis of right ventricular infarction. Am J Med. 1981;70:1175
  22. Mak KH, Chia BL, Tan AT, Johan A. Simultaneous ST-segment elevation in lead V1 and depression in lead V2. A discordant ECG pattern indicating right ventricular infarction. J Electrocardiol. 1994;27:203
  23. Nair R, Glancy DL. ECG discrimination between right and left circumflex coronary arterial occlusion in patients with acute inferior myocardial infarction: value of old criteria and use of lead aVR. Chest. 2002;122:134
  24. Baptista SB, Farto e Abreu P, Loureiro JR, et al. Electrocardiographic identification of the infarct-related artery in acute inferior myocardial infarction. Rev Port Cardiol. 2004;23:963
  25. Geft IL, Shah PK, Rodriguez L, et al. ST elevations in leads V1 to V5 may be caused by right coronary artery occlusion and acute right ventricular infarction. Am J Cardiol. 1984;53:991
  26. Coma-Canella I, Lopez-Sendon J, Alcasena S, Garcia C, Gamallo C, Jadraque LM. Electrocardiographic alterations in leads V1 to V3 in the diagnosis of right and left ventricular infarction. Am Heart J. 1986;112:940
  27. Kataoka H, Kanzaki K, Mikuriya Y. Marked ST-segment elevation in the precordial and inferior leads in right ventricular myocardial infarction: a case report. J Cardiol. 1988;18:541
  28. Eskola MJ, Kosonen P, Sclarovsky S, Vikman S, Nikus KC. The ECG pattern of isolated right ventricular infarction during percutaneous coronary intervention. Ann Noninvasive Electrocardiol. 2007;12:83
  29. Nikus KC. Acute total occlusion of the left main coronary artery with emphasis on electrocardiographic manifestations. TT Top Med Cardiovasc Dis. 2007;11:
  30. Assali AR, Sclarovsky S, Herz I, et al. Comparison of patients with inferior wall acute myocardial infarction with versus without ST-segment elevation in leads V5 and V6. Am J Cardiol. 1998;81:81
  31. Sasaki K, Yotsukura M, Sakata K, Yoshino H, Ishikawa K. Relation of ST-segment changes in inferior leads during anterior wall acute myocardial infarction to length and occlusion site of the left anterior descending coronary artery. Am J Cardiol. 2001;87:1340
  32. Martinez-Dolz L, Arnau MA, Almenar L, et al. Usefulness of the electrocardiogram in predicting the occlusion site in acute anterior myocardial infarction with isolated disease of the left anterior descending coronary artery. Rev Esp Cardiol. 2002;55:1036
  33. Birnbaum Y, Sclarovsky S, Solodky A, et al. Prediction of the level of left anterior descending coronary artery obstruction during anterior wall acute myocardial infarction by the admission electrocardiogram. Am J Cardiol. 1993;72:823
  34. Sclarovsky S, Birnbaum Y, Solodky A, Zafrir N, Wurzel M, Rechavia E. Isolated mid-anterior myocardial infarction: a special electrocardiographic sub-type of acute myocardial infarction consisting of ST-elevation in non-consecutive leads and two different morphologic types of ST-depression. Int J Cardiol. 1994;46:37
  35. Harju JA, Eskola MJ, Huhtala H, Niemela KO, Karhunen PJ, Nikus KC. Recording lead V(4)R is associated to enhanced use of fibrinolytic therapy in acute myocardial infarction. J Electrocardiol. 2006;39:368.e1
  36. Thygesen K, Alpert JS, White HD, Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction . Universal definition of myocardial infarction. Eur Heart J. 2007;28:2525

PII: S0022-0736(08)00497-4

doi: 10.1016/j.jelectrocard.2008.12.009

Journal of Electrocardiology
Volume 42, Issue 2 , Pages 120-127 , March 2009