Implications of ST-segment elevation in leads V5 and V6 in patients with reperfused inferior wall acute myocardial infarction.

During inferior acute myocardial infarction, ST-segment elevation (ST↑) often occurs in leads V(5) to V(6), but its clinical implications remain unclear. We examined the admission electrocardiograms from 357 patients with a first inferior acute myocardial infarction who had Thrombolysis In Myocardial Infarction 3 flow of the right coronary artery or left circumflex artery within 6 hours after symptom onset. The patients were divided according to the presence (n = 76) or absence (n = 281) of ST↑ >2 mm in leads V(5) and V(6). Patients with ST↑ in leads V(5) and V(6) were subdivided into 2 groups according to the degree of ST↑ in leads III and V(6): ST↑ in lead III greater than in V(6) (n = 53) and ST↑ in lead III equal to or less than in V(6) (n = 23). The perfusion territory of the culprit artery was assessed using the angiographic distribution score, and a mega-artery was defined as a score of ≥0.7. ST↑ in leads V(5) and V(6) with ST↑ in lead III greater than in V(6) and ST↑ in leads V(5) and V(6) with ST↑ in lead III equal to or less than in V(6) were associated with mega-artery occlusion and impaired myocardial reperfusion, as defined by myocardial blush grade 0 to 1. Right coronary artery occlusion was most common (96%) in the former, and left circumflex artery occlusion was most common (96%) in the latter, especially proximal left circumflex occlusion (74%). Multivariate analysis showed that ST↑ in leads V(5) and V(6) with ST↑ in lead III greater than that in V(6) (odds ratio 4.81, p <0.001) and ST↑ in leads V(5) and V(6) with ST↑ in lead III equal or less than that in V(6) (odds ratio 5.96, p <0.001) were independent predictors of impaired myocardial reperfusion. In conclusion, ST↑ in leads V(5) and V(6) suggests a greater risk area and impaired myocardial reperfusion in patients with inferior acute myocardial infarction. Furthermore, comparing the degree of ST↑ in lead V(6) with that in lead III is useful for predicting the culprit artery.

Kosuge M ，Ebina T ，Hibi K ，Iwahashi N ，Morita S ，Endo M ，Maejima N ，Gouhara M ，Nagashima Z ，Umemura S ，Kimura K ... -  《-》

Electrocardiographic characteristics in angiographically documented occlusion of the dominant left circumflex artery with acute inferior myocardial infarction: limitations of ST elevation III/II ratio and ST deviation in lateral limb leads.

Zhan ZQ ，Wang W ，Dang SY ，Wang CQ ，Wang JF ，Cao Z ... -  《-》

Acute anterior wall myocardial infarction entailing ST-segment elevation in lead V3R, V1 or aVR: electrocardiographic and angiographic correlations.

Zhong-qun Z ，Wei W ，Chong-quan W ，Shu-yi D ，Chao-rong H ，Jun-feng W ... -  《-》

Value of electrocardiographic algorithm based on "ups and downs" of ST in assessment of a culprit artery in evolving inferior wall acute myocardial infarction.

Fiol M ，Cygankiewicz I ，Carrillo A ，Bayés-Genis A ，Santoyo O ，Gómez A ，Bethencourt A ，Bayés de Luna A ... -  《AMERICAN JOURNAL OF CARDIOLOGY》

Electrocardiographic differentiation between right coronary and left circumflex coronary arterial occlusion in isolated inferior wall myocardial infarction.

Gupta A ，Lokhandwala YY ，Kerkar PG ，Vora AM ... -  《-》