RT Journal Article
SR Electronic
T1 Persistent precordial “hyperacute” T-waves signify proximal left anterior descending artery occlusion
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1701
OP 1706
DO 10.1136/hrt.2009.174557
VO 95
IS 20
A1 N J Verouden
A1 K T Koch
A1 R J Peters
A1 J P Henriques
A1 J Baan
A1 R J van der Schaaf
A1 M M Vis
A1 J G Tijssen
A1 J J Piek
A1 H J Wellens
A1 A A Wilde
A1 R J de Winter
YR 2009
UL http://heart.bmj.com/content/95/20/1701.abstract
AB 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.