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. 2009 Oct 8;32(11):E1–E6. doi: 10.1002/clc.20347

A New Electrocardiographic Algorithm to Locate the Occlusion in Left Anterior Descending Coronary Artery

Miguel Fiol 1,✉, Andrés Carrillo 1, Iwona Cygankiewicz 2, Julio Velasco 1, Maria Riera 1, Antoni Bayés‐Genis 1, Alfredo Gómez 1, Vicente Peral 1, Armando Bethencourt 1, diego Goldwasser 2, Fredis Molina 2, Antoni Bayés de Luna 2
PMCID: PMC6652907  PMID: 19816974

Abstract

Background

Early prediction of proximal left anterior descending coronary artery (LAD) occlusion is essential from a clinical point of view

Hypothesis

To develop an electrocardiogram (ECG) algorithm based on ST‐segment deviations to predict the location of occlusion of LAD as a culprit artery.

Methods

ECG and angiographic findings were correlated in 100 patients with an ST‐segment elevation myocardial infarction (MI) in precordial leads V1, V2, and V4 through V6.

Results

ST‐depression ≥ 2.5 mm in leads III + ventricular fibrillation (VF) presents sensitivity (SE) of 77% and specificity (SP) of 84% for LAD occlusion proximal to the first diagonal artery (D1). ST‐segment in III + VF isoelectric or elevated, presents SE of 44% and SP of 100% for LAD occlusion distal to D1. Subsequent analysis of the equation ∑ of ST‐deviation in VR + V1 − V6 < 0, allows us to predict occlusion distal to first septal artery (S1) with 100% SP. On the other hand, any ST‐depression in III + VF > 0.5 mm + ∑ of ST‐deviation in VR + V1 − V6 ≥ 0 identifies a high‐risk group (lower ejection fraction, worse Killip findings, higher peak of CPK and CK‐MB, and major adverse cardiac events [MACE]: death, reinfarction, recurrent angina, persistent left ventricular failure, or sustained ventricular arrhythmia during hospitalization).

Conclusions

This sequential ECG algorithm based on ST‐segment deviations in different leads allowed us to predict the location of occlusion in LAD with good accuracy. Cases with proximal LAD occlusion present the most markers of poor prognosis. We recommend the use of the algorithm in everyday clinical practice. Copyright © 2009 Wiley Periodicals, Inc.

Keywords: electrocardiography, coronary angiography, acute myocardial infarction

Full Text

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