Abstract

Review Article

Localization of the occluded vessel in acute myocardial infarction

Samir Rafla* and Amr Kamal

Published: 18 February, 2020 | Volume 5 - Issue 1 | Pages: 029-033

This is a review of features in ECG to diagnose the culprit artery responsible for the infarction. Localization of the occluded vessel in acute myocardial infarction is important for many reasons: to know which artery is to dilate and stent; to assess the severity of the lesion; to compare with the echocardiographic area with hypokinesia or akinesia and to differentiate the recent from the old occluded vessel. The ST-segment changes in 12-lead ECG form the basis of diagnosis, management, and prognosis.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001082 Cite this Article Read Full Article PDF

Keywords:

Infarct related artery; Culprit vessel; Acute coronary syndrome; Coronary angiography; Magnetic resonance imaging; Myocardial infarction; Electrocardiogram; ST-elevation

References

  1. Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST- elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 130: 2354–2394. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25249586
  2. Kerensky RA, Wade M, Deedwania P, Boden WE, Pepine CJ, et al. Revisiting the culprit lesion in non-Q-wave myocardial infarction. Results from the VANQWISH trial angiographic core laboratory. J Am Coll Cardiol. 2002; 39: 1456–1463. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11985907
  3. Kim HW, Farzaneh-Far A, Kim RJ. Cardiovascular magnetic resonance in patients with myocardial infarction: current and emerging applications. J Am Coll Cardiol. 2009; 55: 1–16. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20117357
  4. Brener SJ, Milford-Beland S, Roe MT, Bhatt DL, Weintraub WS, et al. Culprit-only or multivessel revascularization in patients with acute coronary syndromes: an American College of Cardiology National Cardiovascular Database Registry report. Am Heart J. 2008; 155: 140–146. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18082505
  5. Budge LP, Salerno M. The role of cardiac magnetic resonance in the evaluation of patients presenting with suspected or confirmed acute coronary syndrome. Cardiol Res Pract. 2011; 2011: 605785. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22028981
  6. Amier RP, Smulders MW, van der Flier WM, Bekkers SCAM, Zweerink A, et al. Long-term prognostic implications of previou PubMed:s silent myocardial infarction in patients presenting with acute myocardial infarction. JACC Cardiovasc Imaging. 2018; 11: 1773–1781. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29680352
  7. Midgette AS, Griffith JL, Califf RM, Laks MM, Dietz SB, et al. Prediction of the Infarct-Related Artery in Acute Myocardial Infarction by a Scoring System Using Summary ST-Segment and T-Wave Changes. Am J Cardiol. 1996; 78: 389-395. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8752181
  8. Thejanandan Reddy CS, Rajasekhar D, Vanajakshamma V. Electrocardiographic localization of infarct related coronary artery in acute ST elevation myocardial infarction. J Clin Sci Res 2013; 2:151-60.
  9. Baltazar RF. Acute Coronary Syndrome: ST Elevation Myocardial Infarction. In: Baltazar RF, editor. Basic and bedside electrocardiography. 1st edition. Baltimore: Lippincott Williams and Wilkins. 2009; 337-339.
  10. Popma JJ. Coronary arteriography. In: Bonow OR, Mann DL, Zipes DP, Libby P, Braunwald E, editors. Braunwald's heart disease. A textbook of cardiovascular medicine. 9th edition. St. Louis: Elsevier Saunders. 2012; 428-431.
  11. Wagner GS, Macfarlane P, Wellens H, Josephson M, Gorgels A, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part VI: acute ischemia/infarction: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol 2009; 53: 1003-1011. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19281933
  12. Fiol M, Carillo A, Cygankiewicz I, Velasco J, Riera M, et al. A New Electrocardiographic Algorithm to Locate the Occlusion in Left Anterior Descending Coronary Artery. Clin Cardiol. 2009; 32: E1-E6. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6652907/
  13. Zimetbaum P, Krishnan S, Gold A, Carrozza JP II, Josephson M. 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; 81: 918-919. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9555783
  14. Zimetbaum PJ, Josephson ME. Use of the electrocardiogram in acute myocardial infarction. N Engl J Med. 2003; 348: 933-940. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12621138
  15. Wellens HJJ. Determining the size of the area at risk, the severity of ischemia, and identifying the site of occlusion in the culprit coronary artery. In: Wellens HJJ, Gorgels APM, Doevendans PA, editors. The ECG in acute myocardial infarction and unstable angina: diagnosis and risk stratification. 2nd edition. Dordrecht: Kluwer Academic Publishers. 2003; 13-43.
  16. Herz I, Assali AR, Adler Y, Solodky A, Sclarovsky S. New electrocardiographic criteria for predicting either the right or left circumflex artery as the culprit coronary artery in inferior wall acute myocardial infarction. Am J Cardiol. 1997; 80: 1343-1345. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9388111
  17. Bairey CN, Shah K, 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: 456-459. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/3630927
  18. Bayes de Luna A, Goldwasser D, Fiol M, Bayes Genis A. Surface electrocardiography. In: Fuster V, Walsh RA, Harrington RA' editors. Hurst's the heart.13th edition. New York: McGraw Hill. 2011; 350-358.
  19. Hasdai D, Birnbaum Y, Herz I, Sclarovsky S, Mazur A, et al. ST segment depression in lateral limb leads in inferior wall acute myocardial infarction: implications regarding the culprit artery and the site of obstruction. Eur Heart J. 1995; 16: 1549-1553. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8881846
  20. Verouden NJ, Barwari K, Koch KT, Henriques JP, Baan J, et al. Distinguishing the right coronary artery from the left circumflex coronary artery as the infarct-related artery in patients undergoing primary percutaneous coronary intervention for acute inferior myocardial infarction. Europace. 2009; 11: 1517-1521. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19706635
  21. Rott D, Nowatzky J, Teddy Weiss A, Chajek-Shaul T, Leibowitz D. ST Deviation Pattern and Infarct-related Artery in Acute Myocardial Infarction. Clin Cardiol. 2009; 32: E29–E32. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19816991
  22. Gorgels AP, Engelen DJ, Wellens HJ. Lead aVR, a mostly ignored but very valuable lead in clinical electrocardiography. J Am Coll Cardiol. 2001; 38: 1355–1356. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11691507
  23. Yamaji H, Iwasaki K, Kusachi S, Murakami T, Hirami R, et al. Prediction of acute left main coronary artery obstruction by 12-lead ECG. ST segment elevation in lead aVR with less ST segment elevation in lead V1. J Am Coll Cardiol. 2001; 38: 1348–1354. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11691506
  24. Thrudeep S, Geofi G, Rupesh G, Abdulkhadar S. Dilemma of localization of culprit vessel by electrocardiography in acute myocardial infarction. Indian Heart J. 2016; 68(Suppl 2): S15–S17. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27751270
  25. Heslop JJ, Narala K, Banga S, Mungee S. Anteroseptal ST elevation myocardial infarction and non-dominant right coronary artery lesion involving acute marginal branch: a dilemma in decision making. JACC. 2015;
  26. Jothieswaran A, Body R. BET 2: Diagnosing acute myocardial infarction in the presence of ventricular pacing: can Sgarbossa criteria help? Emerg Med J. 2016; 33: PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27539980
  27. Sgarbossa EB, Pinski SL, Barbagelata A, Underwood DA, Gates KB, et al. Electrocardiographic Diagnosis of Evolving Acute Myocardial Infarction in the Presence of Left Bundle-Branch Block. N Engl J Med. 1996; 334: 481-487. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8559200

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