Proximal Left Anterior Descending Artery Research Articles

The Comparative Assessment of Wellens' Syndrome With Proximal Left Anterior Descending Artery (LAD) Stenosis Versus Right Coronary Artery (RCA) or Circumflex Coronary Artery Stenosis and Its Prevalence: A Systematic Review.

Wellens'syndrome is well-known for its critical stenosis of the proximal left anterior descending artery (LAD) with characteristic electrocardiographic findings of biphasic or deeply inverted T waves in V2-V6 under specific diagnostic criteria. Although the syndrome is known as a high-grade LAD lesion, its sequence of events can also be seen with the right coronary artery (RCA) and the left circumflex artery (LCX). This systemic review attempts to expand on these findings while analyzing the prevalence of Wellens' syndrome with the RCA and/or the circumflex artery. This study also comparatively indicated that Wellens'syndrome is seen in RCA and circumflex arterystenoses when present; the indication of the same medical management is warranted for effective treatment and survival. We extracted and analyzed 24 case reports each with an atypical presentation of acute coronary syndrome (ACS) and specific Wellens'syndrome pattern of electrocardiogram (ECG) presentation with critical stenosis in the LAD, RCA, and left circumflex artery.The risk of bias assessment was undertaken using internal risk analysis by utilizing medical libraries and certain search phrases to find research articles with the involvement of the LAD as opposed to the RCA and LCX in Wellens' syndrome. Based on the number of respective primary research articles found, a bias calculation was done on the reported respective coronary artery involvement. The finding of our systemic review confirms that Wellens'syndrome is a precordial lead disease with T wave abnormalities that presentwithcritical stenosis of not only the LAD but also the RCA and circumflex artery. The result of our systemic review affirmed that although most Wellens'syndrome cases reported involve the stenosis of the LAD, the critical occlusion of the RCA and/or the circumflex artery was found with Wellens'syndrome pattern of ECG presentation, meaning that the sequence of events is not limited to the proximal LAD.

Effect of Coronary Artery Dominance In-terms of Presentation and In-hospital Outcomes of patients undergoing Primary PCI for Culprit Proximal Left Anterior Descending Artery

Objectives: Objective of this study was to assess the difference in terms of presentation and in-hospital course between patients with right vs. left dominant arterial circulation undergoing “primary percutaneous coronary intervention (PCI)” for culprit proximal left anterior descending artery (LAD). Methodology: We included consecutive adult (≥18 years) patients diagnosed with STE-ACS undergoing primary PCI for culprit proximal LAD. Patients were categorized into right vs. left dominant circulation on left heart catheterization. Demographic, clinical characteristics, presentation, and hospital course were compared between the matched (propensity matched) and unmatched cohort of patients with right vs. left dominance. Results: We included 775 patients, out of which 81.3% (630) were males and mean age was 54.59 ± 11.3 years. On coronary angiogram left dominance was observed in 14.3% (111). Single vessel disease was higher with left compared to right dominant system, 53.2% vs. 43.5%, respectively. The rate of slow flow/no-reflow (15.4% vs. 7.2%; p=0.0.230), heart failure (9.3% vs. 6.3%; p=0.299), and in-hospital mortality (5.1% vs. 3.6%, p=0.493) were not different between right vs. left dominance, respectively. In the matched cohorts, the frequency of slow flow/no-reflow (15.3% vs. 7.2%; p=0.056), heart failure (6.3% vs. 6.3%; p>0.999), and mortality (5.4% vs. 3.6%, p=0.493) were not different between right vs. left dominance, respectively. Conclusion: No significant increase in complications and outcomes is witnessed among patients with left dominant arterial circulation undergoing primary PCI for culprit proximal LAD. However, careful handling of left main during intervention is warranted due lack of support from right system.

Predictors of LV Recovery after Proximal Left Anterior Descending Artery Stenting

Predictors of LV Recovery after Proximal Left Anterior Descending Artery Stenting

TCTAP C-108 Septal Artery Perforation During Wire Advancement for Percutaneous Coronary Intervention of Proximal Left Anterior Descending Artery Calcified Lesion - How We Persevere Till the End

TCTAP C-108 Septal Artery Perforation During Wire Advancement for Percutaneous Coronary Intervention of Proximal Left Anterior Descending Artery Calcified Lesion - How We Persevere Till the End

Type A Wellens' syndrome - A critical electrocardiographic sign

Wellens’ syndrome was first described in 1982[1] and classified into type A and type B. Type A Wellens’ syndrome is characterized by biphasic T-waves in leads V2 and V3, and type B is characterized by deep symmetrical T-wave inversions in the same leads. The study reported that Wellens’ syndrome electrocardiographic (ECG) finding related to left anterior descending (LAD) total or near-total occlusion, which is also described as one of the ST-segment elevation myocardial infarction (STEMI) equivalent signs.[2] Cardiology consultation for possible coronary angiography is necessary for evaluating patients.[3] A 29-year-old male without underlying medical diseases was admitted to our emergency department due to intermittent retrosternal chest tightness for 1 week. His chest pain usually occurs after exertion, accompanied by nausea and dizziness, and subsides 10–15 min after rest. He did not notice other exacerbating or relieving factors. Thus, he visited our emergency department for a consultation. The patient is a nonsmoker with no family history of acute coronary syndrome. In the emergency department, his chest pain had already subsided. He was vitally stable. On physical examination, his cardiac auscultation revealed a regular heartbeat with no murmurs. His ECG performed in the emergency department showed sinus rhythm with biphasic T-waves in leads V2 and V3 without precordial Q waves [Figure 1], which is compatible with type A Wellens’ syndrome. As for his blood examination, his troponin I level is 3.2 ng/mL (normal range < 0.02 ng/mL) and creatine kinase-myocardial band mass is 8.5 ng/mL (normal range <5 ng/mL). He also had thrombocytosis with a platelet count of 993,000/μL.Figure 1: Patient’s initial ECG. ECG: ElectrocardiographicThe patient received aspirin, ticagrelor, and heparin for the myocardial infarction. He received urgent coronary angiography and the examination showed an 85% stenosis of the proximal LAD artery [Figure 2] that was successfully opened through angioplasty. Two drug-eluted stents were placed. After angioplasty, his ECG showed sinus rhythm with no Wellens’ pattern. In addition, he did not experience any chest pain attack after angioplasty. On admission, the patient was diagnosed with essential thrombocythemia through positive JAK-2 V617F mutation test and bone marrow biopsy.Figure 2: Patient’s coronary angiography showed LAD stenosis. (Left) Before the intervention. (Right) After the intervention. LAD: Left anterior descendingWellens’ syndrome is one of the STEMI equivalent ECG signs that need to be treated as acute myocardial infraction in the emergency department.[2] A previous study[1] showed that 75% of the patients with Wellens’ syndrome developed extensive anterior wall myocardial infarction a few weeks after admission. T-wave findings of Wellens’ syndrome are classified into two patterns. In type B, which comprises approximately 75% of cases, the T-wave is deeply inverted and the inverted T-wave is symmetric in contour. In type A, which comprises 25% of cases, the T-wave is biphasic in leads V2 and V3. Other ECG criteria included no loss of R rave or precordial Q waves. Considering noncoronary causes of T-wave inversions, the left ventricular hypertrophy and bundle branch block patterns should be readily recognized by their significant coexistent findings.[3] The characteristic ECG pattern often develops when the patient is not experiencing angina.[3] Patients with ET may present with vasomotor symptoms such as myocardial infarction or stroke. However, in this case, the patient was young and without any risk factors for myocardial infarction before diagnosis. Prompt recognition of the ECG pattern and early cardiology consultation are essential to prevent missing the diagnosis of myocardial infarction. Declaration of patient consent The authors certify that they have obtained appropriate patient consent form. In the form, the patient has given his consent for the images and other clinical information to be reported in the journal. The patient understands that name and initial will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Presence of ramus intermedius increases the risk of atherosclerotic plaque formation at the left main bifurcation's region: A retrospective study from CT coronary angiography in UMMC

<h2>Background</h2> Ramus intermedius (RI) is a variant vessel arising from the left main bifurcation angle (LMBA). Haemodynamically, its presence increases coronary turbulence flow and reduces the endothelial shear stress. In theory, this haemodynamic effect promotes atherosclerotic plaque formation, especially around the bifurcation region. <h3>Objectives</h3> This study aims to identify RI as a risk factor for atherosclerosis at the left main coronary artery (LMCA), proximal left anterior descending (LAD) and proximal left circumflex (LCx) using coronary computed tomography angiography (CCTA). <h3>Methodology</h3> A retrospective review was carried out on 374 CCTA cases in University Malaya Medical Centre (UMMC) between January 2017 and December 2018. The atherosclerotic plaque at the LMCA, proximal LAD and proximal LCx arteries were analysed in the presence or absence of RI. Statistical analysis was done using the chi-square test and binary logistic regression. <h3>Results</h3> RI was identified in 32.4% (<i>n</i> = 121) of patients. Age > 65 years old, male gender, diabetes, hypertension and RI were identified as significant risk factors for atherosclerosis. The presence of RI increases plaque formation by 8.5-fold for proximal and distal LMCA compared to those without RI (aOR: 8.5, 95% CI: 1.7, 43.0, <i>p</i> > 0.001). Meanwhile, at the proximal LAD, RI increases the risk for plaque formation by 3.7 folds (aOR: 3.7, 95% CI: 1.5, 9.4 <i>p</i> = 0.006) at the lateral wall and by 4.9 folds (aOR: 4.9, 95% CI: 1.7, 14.2, <i>p</i> = 0.003) for both lateral and medial wall. RI also independently increases the risk for atherosclerosis by 3 folds at the lateral and medial wall of proximal LCx (aOR: 3.7, 95% CI: 1.2, 11.4, <i>p</i> = 0.020). Lastly, RI increases the risk of obstructive stenosis in the LMCA, LAD and LCx by 3.9 folds (aOR: 3.9, 95% CI: 1.4, 10.5, <i>p</i> < 0.001). <h3>Conclusion</h3> Our findings suggest that the presence of RI independently increases the risk for atherosclerotic plaque formation in the left main stem and its proximity. RI in situ is believed to exert altered haemodynamic effect promoting atherosclerotic plaque formation.

C44. Electrocardiogram might failed identify acute coronary occlusion: When every minute counts

Abstract Backgrounds Prompt diagnosis of acute coronary occlusion based on electrocardiogram (ECG) are essential to decide proper treatment. However, particular ECG such as Wellens syndrome have been higlighted without obvious ST-segmen elevation which is signifies critical stenosis or occlusion of the proximal left anterior descending (LAD) artery but unfortunately is often unrecognized by physicians. Case Illustration A 51-year old male patient referred from district hospital diagnosed as five day onset STEMI with recurrent chest pain. The first ECG in there emergency room was a deep inverted T wave in anterior and lateral lead that immediate intervention approach not choosen. The typical infarct evolution in anteroseptal lead appear one day after the onset. Troponin level was significantly increased. Urgent angiography was performed in our hospital, unfortunately it resulted critical stenosis in proximal LAD with triple vessels and left main coronary artery disease. Then we consider send to surgery due to high coronary complexity (Syntax score:62) and optimize antianginal agent. Discussion In current practice, ST-segment elevation at the J-point, ≥ 1 mm in ≥ 2 adjacent leads (other than leads V2 and V3, where elevation of ≥ 2 mm in men or ≥ 1.5 mm in women is considered significant) for STEMI diagnosis. However, these general ECG criteria fail to identify the STEMI equivalents. Wellens syndrome is one of them that suggesting severe stenosis of the proximal LAD artery, which will develop into an acute anterior wall MI within a few days to weeks in 75% of untreated patients.

C44. Electrocardiogram might failed identify acute coronary occlusion: When every minute counts

Abstract Backgrounds Prompt diagnosis of acute coronary occlusion based on electrocardiogram (ECG) are essential to decide proper treatment. However, particular ECG such as Wellens syndrome have been higlighted without obvious ST-segmen elevation which is signifies critical stenosis or occlusion of the proximal left anterior descending (LAD) artery but unfortunately is often unrecognized by physicians. Case Illustration A 51-year old male patient referred from district hospital diagnosed as five day onset STEMI with recurrent chest pain. The first ECG in there emergency room was a deep inverted T wave in anterior and lateral lead that immediate intervention approach not choosen. The typical infarct evolution in anteroseptal lead appear one day after the onset. Troponin level was significantly increased. Urgent angiography was performed in our hospital, unfortunately it resulted critical stenosis in proximal LAD with triple vessels and left main coronary artery disease. Then we consider send to surgery due to high coronary complexity (Syntax score:62) and optimize antianginal agent. Discussion In current practice, ST-segment elevation at the J-point, ≥ 1 mm in ≥ 2 adjacent leads (other than leads V2 and V3, where elevation of ≥ 2 mm in men or ≥ 1.5 mm in women is considered significant) for STEMI diagnosis. However, these general ECG criteria fail to identify the STEMI equivalents. Wellens syndrome is one of them that suggesting severe stenosis of the proximal LAD artery, which will develop into an acute anterior wall MI within a few days to weeks in 75% of untreated patients.

Total Proximal Left Anterior Descending Artery Occlusion Presenting as Right Sided Chest Pain with a Misdiagnosis of Costochondritis: A Case Report

Background Acute coronary syndrome refers to a group of clinical symptoms consistent with acute myocardial ischemia or infarction that are potentially life threating requiring immediate interventions. Certain proportion of patients can present with atypical symptoms leading to a missed diagnosis associated with devastating outcomes. Case presentation We present a 60 years’ female of African descent with a medical history of hypertension and type 2 Diabetes mellitus who presented with a 2 months’ history of right-sided anterior chest pain and was diagnosed with costochondritis. Further assessment revealed, normal cardiac markers and an electrocardiogram suggestive of anterior wall myocardial infarction. A coronary computed tomography and cardiac magnetic imaging scans revealed a total occlusion of the proximal left anterior descending artery and a viable myocardium respectively. She underwent successful percutaneous coronary interventions with stenting with complete alleviation of her chest pain. Conclusions This case report highlights the importance of having a high index of suspicion in high-risk groups such as older females with co-morbidities presenting with atypical symptoms suggestive of acute coronary syndrome to health care providers. This ensures early diagnosis and provision of appropriate treatment associated with good outcomes. Likewise, the case also advocates on the use of advanced cardiac imaging in patients with inconclusive electrocardiographic and biochemical tests.

Abstract 14062: Accuracy of Exercise Induced St- Elevation in Lead Avr in the Diagnosis of Significant Left Main or Proximal Left Anterior Descending Artery Stenosis: A Systematic Review

Introduction: ST-segment changes during exercise stress testing are diagnostic of myocardial ischemia in patients with suspected coronary artery disease (CAD). Recent studies have shown that exercise-induced ST-elevation in aVR is associated with significant stenosis of the left main (LM) and proximal left anterior descending (pLAD) arteries Methods: Search of electronic databases (Embase, Medline, and Web of Science) using MeSH terms and keywords for exercise stress test, lead aVR and CAD was performed from inception through December 2019. 2 reviewers independently screened results in 2 stages: title/abstract followed by full text. Included studies had adult patients who underwent exercise stress testing and reported the performance of ST-elevation &gt;1 mm in lead aVR for diagnosing significant LM or pLAD disease. Significant disease was defined as luminal narrowing &gt;50% and &gt;70% for LM and pLAD respectively. Pooled sensitivity, specificity, likelihood ratios (LR) and diagnostic odds ratios were calculated using a bivariate model, and a summary receiver operator curve (SROC) was constructed. Results: We included 6 studies with 1128 patients. The pooled sensitivity was 0.8 (95% CI 0.36-0.97; I 2 =94.7) and pooled specificity was 0.78 (95% CI 0.56-0.90; I 2 =97.8). Overall calculated positive LR was 3.56 (95% CI 2.34-5.4) and negative LR was 0.26 (95% CI 0.07-1.01). The pooled diagnostic odds ratio was 13.5 (95% CI 4.8-38.5). Hierarchical SROC curve showed an area under the curve of 0.84 (95% CI 0.81-0.87) (Figure 1). Conclusions: Our analysis showed moderate sensitivity and specificity of exercise-induced aVR ST-elevation for diagnosing significant LM or pLAD disease. The heterogeneity among studies was high, likely due to differences in patient selection. In conclusion, ST-elevation in aVR during exercise stress test increases the likelihood of having LM or pLAD disease. Large studies are needed to substantiate this finding.

Revascularization for Isolated Proximal Left Anterior Descending Artery Disease

Most studies of patients with isolated proximal left anterior descending (PLAD) coronary artery disease do not include all 3 procedural options: percutaneous coronary intervention (PCI), conventional coronary artery bypass graft (CABG) surgery, or minimally invasive CABG. New York's cardiac registries were used to identify patients who underwent revascularization for isolated PLAD disease between January 1, 2010, and November 30, 2016, in New York State. After exclusions, 14,327 patients, of whom 13,115 received PCI, 1001 of whom underwent CABG surgery, and 211 of whom underwent minimally invasive CABG were monitored through the end of 2017 to compare outcomes. Registry data were matched to vital statistics data to obtain deaths occurring after discharge and matched to claims data to obtain subsequent admissions for myocardial infarction and stroke. There were no significant differences in mortality or in mortality/myocardial infarction/stroke after 7 years (with median follow-up times in excess of 4 years) among the 3 procedures after adjusting fordifferences in patient risk factors. However, conventional CABG surgery was associated with a lower subsequent revascularization rate than PCI (adjusted hazard ratio, 0.45; 95% confidence interval, 0.35-0.58) and minimally invasive CABG surgery (adjusted hazard ratio, 0.46; 95% confidence interval, 0.32-0.66). Among patients with isolated PLAD disease undergoing any of 3 revascularization options (PCI, conventional CABG surgery, or minimally invasive CABG surgery), conventional CABG surgery was associated with lower subsequent revascularization rates, but there were no differences in mortality or mortality/myocardial infarction/stroke rates.

Macrophage accumulation within coronary arterial wall in diabetic patients with acute coronary syndrome: a study with in-vivo intravascular imaging modalities

Background and aimsMacrophage accumulation in arteriosclerotic plaque of coronary arteries is involved in plaque destabilization. Atherosclerosis has been known to be progressive in patients with type 2 diabetes mellitus (DM). This study compared the features of 3-dimensional (3D) spatial distribution of macrophage accumulation within coronary artery wall between acute coronary syndrome (ACS) patients with DM (n = 20) and those without (non-DM, n = 20) by using intravascular ultrasound (IVUS) and optical coherence tomography (OCT).MethodsThe OCT-derived macrophage accumulation was measured within the proximal left anterior-descending artery. This measurement was performed for the whole vessel segment of interest, higher shear stress region (flow divider side) and lower shear stress region (the opposite side).ResultsNormalized macrophage accumulation per unit length of the whole segment of interest was significantly larger in ACS patients with DM than without. In non-DM patients, macrophage density per IVUS-derived plaque volume was significantly higher in high shear stress region compared to low shear stress region, however, there was no significant difference between the two regions in DM patients. The macrophage density in the low shear stress region was significantly higher in the DM group than in the non-DM group. A multivariate analysis showed that the presence of DM was a major determinant for macrophage distribution.ConclusionsMacrophage accumulation was more abundant and homogeneous within coronary arterial wall in DM patients with ACS compared to non-DM patients, suggesting that plaque destabilization may occur more widely throughout coronary wall in DM patients.

Correction to: Proximal Left Anterior Descending Artery Treatment Using a Bioresorbable Polymer Coating Sirolimus-Eluting Stent: Real-World Outcomes From the Multicenter Prospective e-Ultimaster Registry.

Correction to: Proximal Left Anterior Descending Artery Treatment Using a Bioresorbable Polymer Coating Sirolimus-Eluting Stent: Real-World Outcomes From the Multicenter Prospective e-Ultimaster Registry.

Predictive value of the CHA2DS2-VASc Score in detecting in-stent restenosis among patients who underwent previous revascularization due to stable angina or acute coronary syndromes

Abstract Background Introduction of coronary stents in the field of interventional cardiology has significantly improved short- and long-term results of the percutaneous coronary interventions but in the same time they became responsible for development of a new entity called neo-intimal hyperplasia (NIH). If overexpressed, NIH can lead to so-called in-stent restenosis (ISR). Objective To assess the predictive value of the CHA2DS2-VASc Score in detecting in-stent restenosis among patients who underwent previous revascularization in Proximal Left Anterior Descending(LAD) Artery using Drug Eluting Stents (DES) due to stable angina and acute coronary syndrome. Material and Methods This study was conducted over 113 pateints to assess the predictive value of the CHA2DS2-VASc Score in detecting in-stent restenosis among patients who underwent previous revascularization in Proximal Left Anterior Descending (LAD) Artery using Drug Eluting Stents (DES). Results From the study population collected(n = 113), 18.4% of which were females (n = 21), statistically significant relation was found between DES-ISR and CHADSVasc score (p value =0.033). A significant relationship existed between ISR and CHADVasc score 3 or more, and each of: Age(p value= 0.022), DM(p value=0.029), SBP during the procedure(p value = 0.036), time since the PCI was done(p value =0.001), stent length(p value=0.028), pattern of the lesion and management of the lesions as individual variables (p value less than0.001). However, non-significant relationship could be concluded between ISR and each of gender(p value= 0.987), CHF(p value=0.163), HTN(p value=0.446), vascular diseases (p value=0.662), CAD type (SCAD or ACS)(p value=0.616), DBP during the procedure(p value=0.167), creatinine clearance (p value=0.69), HBA1c(p value=0.091), use of DAPT(p value=0.198), the duration of DAPT use(p value=0.873), type of P2Y12 inhibitor used(p value=0.083), use of statins(p value=0.402), beta blockers or nitrates (p values= 1 &amp; 0.836, respectively) and stent diameter used (p value=0.615) Conclusion This study was able to show a significant relationship between ISR and each of CHADVasc score, Age, DM, SBP during the procedure, time since the PCI was done, stent length used, pattern of the lesion and management of the lesions

P1555 Delta mapse: an easy-to-use tool to evaluate coronary artery stenosis during dypiridamole pharmacological stress echocardiography

Abstract Background Dypiridamol stress echocardiography (DSE) is an important tool for detecting reversible ischemia in patients with suspected coronary artery disease (CAD); nonetheless the results of the test are related to visualization of wall motion abnormalities, moderately operator-dependent, and left anterior descending (LAD) artery reserve, resulting in a moderate sensibility and specificity. Aim of our study was to evaluate whether an an easy-to-use parameter like mitral annular plane systolic excursion (MAPSE) could be useful to identify CAD during DSE. Methods We prospectively enrolled 300 patients with suspected CAD and perform a DSE; at rest and peak MAPSE was acquired. 59 patients with reversibile ischemia during stress echocardiography (positive) were referred to perform coronary angiography. Patients were divided according to MAPSE behaviour during DSE: group 1 (MAPSE ≤ 0) and group 2 (delta MAPSE &amp;gt; 0 mm). Results The mean age of was 63 ± 11 years, male gender was prevalent (73%); no differences were found in risk factors and left vetnricular ejection fraction (LV-EF) between two groups.Coronary arteries were normal in 14 patients (23%), while significant stenosis (&amp;gt;70%) was found in 45 patients (77%); in 31 patients (53%) left main (LM) or proximal LAD artery were involved, while in 17 (29%) and 22 (37%) right coronary artery and circumflex artery were affected respectively. Patients with CAD showed a lower (blunted or no increase) MAPSE after dypiridamole infusion, with a significative difference in Delta Mapse (Mapse peak-Mapse rest) between groups (0,2 mm vs 2,8 mm p = 0,004) (Figure 1B). By using a Receiver Operating Curve, the Area under the curve was 0,757, with the best cut-off value for CAD prediction at Delta Mapse= +2.5 mm (sensibility 0,667 and specificity 0,809 – p = 0.012 - Figure 1b). In particular, Delta Mapse was able to predict LM/LAD stenosis (Figure 1B AUC = 0.679 ;p = 0.019), rather than right coronary artery and circumflex artery disease, with higher predictivity than delta LV-EF (AUC = 0.577; p = 0.077). Discussion To our knowledge, this is the first study that compared the behaviour of MAPSE during dypiridamole infusion in patient with and withouth coronary artery disease. MAPSE is a well-known surrogate of longitudinal systolic function and have increased sensitivity over traditional methods of systolic performance such as LV-EF; in this context, dypiridamole induced reversible ischemia could affect prematurely MAPSE then EF or wall motion abnormalities. In our study, in patients with evidence of reversible ischemia during DSE, a blunted or no increase of MAPSE was able to predict CAD, mostly driven by LM/LAD disease, on top of other well known markers of ischemia. Incorporating this easy-to-use parameter could improve specificity of DSE and strenghten the suspect of reversibile ischemia when clear wall motion abnormalities are not found. Abstract P1555 Figure 1A and 1B

Short Term Outcome of Primary Precutaneous Coronary Intervention in Ostial Versus Non Ostial Culprit Proximal Left Anterior Descending Artery Acute Myocardial Infraction

Short Term Outcome of Primary Precutaneous Coronary Intervention in Ostial Versus Non Ostial Culprit Proximal Left Anterior Descending Artery Acute Myocardial Infraction

A patient with simultaneous anterior and inferior ST-segment elevation after percutaneous coronary intervention

A patient who presented with acute inferior-right ventricular (RV) ST-segment elevation (STE) myocardial infarction (MI) is described. Coronary angiography showed a mid-right coronary artery (RCA) occlusion and high-grade proximal left anterior descending (LAD) artery stenoses. Electrocardiography (ECG) after stent angioplasty to the RCA showed new STE in leads V1-V6. Whereas STE pattern recognition was misleading, ECG analysis using vector concepts enabled exclusion of anterior MI due to proximal LAD artery occlusion and recognition of the RV origin of this ECG picture. The ability of the ECG to “capture” RV dilation that enabled the manifestation of this ECG picture is highlighted.

Prevalence of junctional ST-depression with tall symmetrical T-waves in a pre-hospital field triage system for STEMI patients

IntroductionThe prevalence of the junctional ST-depression with tall symmetrical T-waves in a field triage system for ST-Elevation Myocardial Infarction (STEMI) is unknown. Material and methodsWe prospectively collected all transmitted 12-lead electrocardiograms (ECGs) from the STEMI field triage system in Amsterdam from 2011 to 2013. Electrocardiograms with junctional ST-depression with tall symmetrical T-waves were recognized and angiographic documentation and clinical follow up were collected. ResultsA total of 5588 patients with at least 1 transmitted field ECG were identified from the database. ST-elevation infarction was present on the field ECG in 1864 patients (33%) and 701 ECGs (12,5%) showed anterior infarction. In 11 patients, junctional ST-depression with tall symmetrical T-waves was identified (0,2% of total transmitted ECGs and 1,6% of anterior infarctions). The 11 angiograms invariably showed involvement of the proximal Left Anterior Descending (LAD) artery (segment 5,6 and 7). Mortality was 27% within the first week. ConclusionsAn ECG with junctional ST-depression with tall symmetrical T-waves is an infrequent finding. Because this pattern of STEMI equivalent is associated with LAD occlusions, it is important to recognize this pattern, so patients can be transported to the catheterization laboratory without delay.

Long-Term Mortality Following Percutaneous Coronary Intervention to the Proximal Left Anterior Descending Artery: A Multi-Centre Australian Registry Review

Long-Term Mortality Following Percutaneous Coronary Intervention to the Proximal Left Anterior Descending Artery: A Multi-Centre Australian Registry Review

TCTAP C-288 Drug-coated Balloon Angioplasty for Proximal Left Anterior Descending Artery Lesion: Lumen Enlargement and Plaque Modification After 5 Months Follow-up

### Patient initials or identifier number YJ ### Relevant clinical history and physical exam Age: 35, Sex: male Chief Complaint: effort chest pain for 1 year, more severe 2 months. Present Illness: 1 years ago, after working the patient always felt chest pain, more severe in the left side,