Chest
Clinical InvestigationsCardiologyECG 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
Section snippets
Materials and Methods
Thirty consecutive patients at the Medical Center of Louisiana who had symptoms compatible with acute MI, ST-segment elevation in the inferior ECG leads, an appropriate rise and fall of creatine kinase and troponin I levels, and coronary arteriography within 7 days of the onset of symptoms were included in the study. Exclusion criteria were bundle-branch block, prior Q-wave MI, prior coronary artery bypass graft operation, and inability to identify the culprit lesion (in two patients, one of
Results
In 25 of 30 patients, the culprit lesion was in the RCA while in 5 patients it was the LCX (Table 1). In four of five patients with ST-segment depression ≥ 1.0 mm in lead aVR, the culprit lesion was in the LCX. Conversely, the culprit lesion was in the RCA in 24 of the 25 patients with ST-segment elevation (2 RCA), an isoelectric ST segment (18 RCA), or ST-segment depression < 1.0 mm (4 RCA, 1 LCX) in lead aVR.
ST-segment elevation in lead III exceeded that in lead II in 26 patients, and 23 of
Discussion
Among our 30 patients with acute inferior MI, the culprit lesion was in the RCA in 25 patients and in the LCX in 5 patients, a ratio of 5:1. Ten other studies of patients with acute inferior MI have found RCA to LCX ratios ranging from 2.2:1 to 7.0:1, and averaging 3.9:1.2389101112131415 Thus, the RCA is much more likely than the LCX to contain the culprit lesion in patients with acute inferior MI. Rarely, acute inferior MI may result from occlusion of the recurrent LAD branch,23 which is the
ACKNOWLEDGMENT
We thank Mrs. Brenda Kuss for her assistance with this article.
References (26)
- et al.
Correlation of angiographic findings and right (V1 to V3) versus left (V4 to V6) precordial ST-segment depression in inferior wall acute myocardial infarction
Am J Cardiol
(1999) - et al.
Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction
J Am Coll Cardiol
(2001) - et al.
Right ventricular involvement with acute inferior wall myocardial infarction identifies high risk of developing atrioventricular nodal conduction disturbances
Am Heart J
(1984) - et al.
Value of the ST-T segment in lead V4R in inferior wall acute myocardial infarction to predict the site of coronary arterial occlusion
Am J Cardiol
(1988) - et al.
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) - et al.
New electrocardiographic criteria for predicting the site of coronary artery occlusion in inferior wall acute myocardial infarction
Am J Cardiol
(1998) - et al.
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) - et al.
Ratio of ST-segment depression in lead V2 to ST-segment elevation in lead aVF in evolving inferior acute myocardial infarction: an aid to the early recognition of right ventricular ischemia
Am J Cardiol
(1986) - et al.
Simultaneous ST-segment elevation in lead V1 and depression in lead V2: a discordant ECG pattern indicating right ventricular infarction
J Electrocardiol
(1994) - et al.
Panoramic display of the orderly sequenced 12-lead ECG: position paper
J Electrocardiol
(1994)