With interest we read the comment by Eskola and colleagues1 on our systematic observation of a characteristic ECG pattern associated with acute and persistent occlusion of the proximal left anterior descending (LAD) artery.2 The pattern of “hyperacute T waves” has been described before, but has invariably been described previously as a transient phenomenon associated with anterior ischaemia, but not with persistent LAD occlusion. With careful serial observation and simultaneous coronary angiography, we have shown, in contrast to previous reports, that these ECG changes may be associated with persistent LAD occlusion.

We are …