Abstract
Background The correlation between ST-segment elevation (ST↑) in lead V 3R (ST↑ V3R), lead V 1 (ST↑ V1), and lead aVR (ST↑ aVR) during anterior wall acute myocardial infarction (AMI) and the culprit lesion site in the left anterior descending (LAD) coronary artery and the nature of the conal branch of the right coronary artery has not been throughly described. Methods One hundred forty-two patients with first anterior wall AMI were included. The 15-lead electrocardiogram with the standard 12 leads plus leads V 3R through V 5R showing the most pronounced ST-segment deviation before initiation of reperfusion therapy was evaluated and correlated with the exact LAD occlusion site in relation to the first septal perforator (S1) and the nature of the conal branch of the right coronary artery as determined by coronary angiography. Results ST-segment elevation in lead aVR, ST↑ V1 of at least 2 mm, and ST↑ V3R of at least 1 mm were more prevalent among patients with occlusions proximal to S1 than patients with occlusions distal to S1 (41.7% vs 4.9%, P < .01; 30.0% vs 7.3%, P < .01; and 91.7% vs 4.9%, P < .01, respectively). Of the 60 patients with occlusions proximal to S1, 20 patients had a small conal branch (18 patients with ST↑ aVR and 15 patients with ST↑ V1 ≥2 mm), and 24 patients had a large conal branch (all patients with non-ST↑ aVR and ST↑ V1 <2 mm; P < .01). The sensitivity of ST↑ V1 of more than 1 mm, of at least 2 mm, ST↑ V3R of at least 1.5 mm, and ST↑ aVR for detecting a small conal branch was 65.1%, 81.8%, 84.0%, and 90%, respectively; the specificity was 68.5%, 64%, 66.7%, and 64.9%, respectively. Conclusions In patients with anterior wall AMI, ST↑ V3R of at least 1 mm combined with ST↑ in leads V 2 through V 4 were strongly predictive of LAD occlusion proximal to S1; furthermore, ST↑ aVR and ST↑ V1 of at least 2 mm were found to be useful in identifying LAD occlusion proximal to S1. ST↑ aVR, ST↑ V3R of at least 1.5 mm, and ST↑ V1 of at least 2.0 mm were also associated with the presence of a small conal branch not reaching the intraventricular septum during anterior wall AMI.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
