Original articles

Acute coronary syndromes

Persistent precordial "hyperacute" T-waves signify proximal left anterior descending artery occlusion

N J Verouden¹, K T Koch¹, R J Peters¹, J P Henriques¹, J Baan¹, R J van der Schaaf¹, M M Vis¹, J G Tijssen¹, J J Piek¹, H J Wellens², A A Wilde¹, R J de Winter¹

¹ Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
² Cardiovascular Research Institute, Maastricht, The Netherlands

^{Correspondence to} Professor Robbert J de Winter, Department of Cardiology, B2-137, Academic Medical Center, Meibergdreef 9, PO box 22660, 1100 DD Amsterdam, The Netherlands; r.j.dewinter{at}amc.uva.nl

Objective: To describe patients with a distinct electrocardiogram (ECG) pattern without ST-segment elevation in the presence of an acute occlusion of the proximal left anterior descending (LAD) artery.

Design: Single-centre observational study.

Patients: Patients with acute anterior wall myocardial infarction who were referred for primary percutaneous coronary intervention (PCI) between 1998 and 2008.

Results: We identified patients with a static, distinct ECG pattern without ST-segment elevation and an occlusion of the proximal LAD artery during urgent coronary angiography before PCI. Of 1890 patients who underwent primary PCI of the LAD artery, we could identify 35 patients (2%) with this distinct ECG pattern. The ECG showed ST-segment depression at the J-point of at least 1 mm in precordial leads with upsloping ST-segments continuing into tall, symmetrical T-waves. Patients with this distinct ECG pattern were younger, more often male and more often had hypercholesterolaemia compared to patients with anterior myocardial infarction and ST-segment elevation.

Conclusions: In patients presenting with chest pain, ST-segment depression at the J-point with upsloping ST-segments and tall, symmetrical T-waves in the precordial leads of the 12-lead ECG signifies proximal LAD artery occlusion. It is important for cardiologists and emergency care physicians to recognise this distinct ECG pattern, so they can triage such patients for immediate reperfusion therapy.

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