: ST. Key Words. J Cardiol 2003 Jun; 41 6 : Diagnostic techniques

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1 J Cardiol 2003 Jun; 416: : ST Electrocardiographic Discrimination of Infarct-Related Artery Between Left Circumflex and Right Coronary Artery: Comparison of ST Elevation Between Leads and Ikuo Hiroyuki Koichi Hirofumi Kenji Takashi MISUMI, MD SHONO, MD NAKAO, MD MATSUDA, MD HORIUCHI, MD HONDA, MD, Abstract Objectives. Admission electrocardiography was evaluated to discriminate left circumflex arterylcx versus right coronary arteryrcaas the cause of acute myocardial infarction. Methods. Electrocardiographic findings were assessed in patients with RCAn60and LCXn 60 occlusion. Results. ST segment elevation in the inferior leads or right precordial leads was more common in the RCA group. ST segment depression or negative T wave was more common in leads, al in the RCA group. ST segment elevation was more common in leads 5, 6 in the LCX group. ST segment was elevated in inferior leads in 55 patients in the RCA group and 27 patients in the LCX group. Mean ST level was higher in leadthan in leadin the RCA group, but not in the LCX group. The ST level was higher in lead than in leadin 78% of the RCA group, but only 44% of the LCX groupp0.01. Conclusions. Comparison of ST levels between leadsand, and a three-dimensional analysis in 12- lead electrocardiography is useful for discriminating the left circumflex artery from the right coronary artery as the cause of acute myocardial infarction. J Cardiol 2003 Jun ; 416: Key Words Myocardial infarction, pathophysiology Diagnostic techniques Electrocardiography 12 1 : ; : Division of Internal Medicine, Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto; presentdivision of Cardiology, Arao City Hospital, Kumamoto Address for correspondence : HONDA T, MD, FJCC, Division of Internal Medicine Cardiovascular Center, Saiseikai Kumamoto Hospital, Chikami 531, Kumamoto, Kumamoto Manuscript received January 9, 2003 ; revised March 7, 2003; accepted March 17,

2 272 Table 1ST segment deviation in patients with acute myocardial infarction due to right coronary artery or left circumflex artery occlusion Ageyr, meansd Male Total occlusion of IRCA STin,, af STin,, af ST in 5, 6 STin, al STin, al ST in 2 5 R/S ratio1 in 1 STin right precordial leads Infarct-related coronary artery RCA group n /5452 LCX group n /452 p value : %. STin,, af and right precordial leads, and STin, al were more common in the RCA group than in the LCX group. STin 5, 6 and STin,, af were more common in the LCX group than in the RCA group. RCAright coronary artery ; LCXleft circumflex artery ; IRCA STST segment elevation ; STST segment depression. ST ; ; Table ST ST af 5 6 al R/S 1 ST ST STFig. 1 ST 0.4 mv ST 0.55mV ST 2 t 2 p ST Table J Cardiol 2003 Jun; 416:

3 273 Fig. 1 ST segment elevation in leads and in a patient ST segment was 0.15 mv higher in lead 0.55mV than lead0.4mv. af ST 92%45% p ST 3% 28%p ST 17% 42%p ST 48%63% 1 R/S1 5% al ST 2% 8%ST T 82% 25%p ST 52% 2%p Fig. 2 ST al ST T Fig. 2 ST segment deviations in all 120 cases ST segment elevation was common in the right precordial leads and leads,, af, and ST segment depression in, al in the RCA group. ST segment elevation was observed in leads 5, 6 in the LCX group. ST segment depression in leads 2 5 was similar in both groups. RV right ventricle ; LVleft ventricle. Other abbreviations as in Table 1. ST ST 5 6 ST 2 5 ST 2 ST Table 2 120aF ST ST mV vs mvp mV vs mv ST ST 78% vs44%p 0.01 ; Fig ST 16% 70%p ST 51% J Cardiol 2003 Jun; 416:

4 274 Table 2ST segment deviation in patients with ST segment elevation in leads,, af Infarct-related coronary artery RCA group n55 LCX group n27 p value Ageyr, meansd Male ST segment deviation inandmv, meansd ST in 5, 6 STor negative T wave in, al ST in R/S1 in STin right precordial leads 28/4957 1/195 : %. ST level was higher in leadthan in leadin the RCA group, but there was no difference in the LCX group. STin 5, 6 was more common in the LCX group than in the RCA group. STin the right precordial leads was more common in the RCA group than in the LCX group. Abbreviations as in Table 1. p, comparison of ST levels betweenand. Fig. 3 ST segment deviations in the RCA and LCX groups More patients with ST segment elevation in the inferior leads82 patientshad higher ST levels in leadthan in leadin the RCA group78%than in the LCX group 44%. Abbreviations as in Table 1. 67% 1 R/S1 5%4% ST 57% 5%p alstt 51% 4%p Fig. 4 af ST ST 2 5 STT ST 5 6 ST J Cardiol 2003 Jun; 416:

5 275 Fig. 4 ST segment deviations in 82 patients with ST segment elevation in leads,, af ST segment elevation was common in the right precordial leads and in leads, and ST segment depression was observed in, al in the RCA group. ST segment elevation was observed in leads, and in 5, 6 in the LCX group. ST segment depression in leads 2 5 was similar in both groups. Abbreviations as in Table 1, Fig. 2. ST 92% 45% ST ST 1 R/S1 Q ST Bairey 4 ST 5 6 al ST alst Fig. 2 ST 5 af ST ST Table 2 Fig. 3 Figs : 6060 : ST al STT 5 6 ST 2 5 STST ST ST ST78% 44%p 0.01 : 12STST J Cardiol 2003 Jun; 416: J Cardiol 2003 Jun; 416:

6 276 1Blanke H, Cohen M, Schlueter GU, Karsch KR, Rentrop KP: Electrocardiographic and coronary arteriographic correlations during acute myocardial infarction. Am J Cardiol 1984; 54 : Fuchs RM, Achuff SC, Grunwald L, Yin FC, Griffith LS : Electrocardiographic localization of coronary artery narrowings : Studies during myocardial ischemia and infarction in patients with one-vessel disease. Circulation 1982; 66: Sclarovsky S, Topaz O, Rechavia E, Strasberg B, Agmon J: Ischemic ST segment depression in leads 2 3 as the presenting electrocardiographic feature of posterolateral wall myocardial infarction. Am Heart J 1987 ; 113: 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 : Carson W : Patterns of maximal spatial ST vector of ST segment elevation in the right precordial leads of the electrocardiogram in patients with acute inferior myocardial infarction. Eur Heart J 1988 ; 9: J Cardiol 2003 Jun; 416: