{"pk":18135,"title":"Pre-Hospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction","subtitle":null,"abstract":"Introduction: Acute anterior myocardial infarctions caused by proximal left anterior descending (LAD) artery occlusions are associated with a higher morbidity and mortality. Early identification of high-risk patients via the 12-lead electrocardiogram (ECG) could assist physicians and emergency response teams in providing early and aggressive care for patients with anterior ST-elevation myocardial infarctions (STEMI). Approximately 25% of US hospitals have primary percutaneous coronary intervention (PCI) capability for the treatment of acute myocardial infarctions. Given the paucity of\n\n\nhospitals capable of PCI, early identification of more severe myocardial infarction may prompt\n\n\nemergency medical service routing of these patients to PCI-capable hospitals. We sought to determine if the 12 lead ECG is capable of predicting proximal LAD artery occlusions.\n\n\nMethods: In a retrospective, post-hoc analysis of the Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization pilot trial, we compared the ECG findings of\n\n\nproximal and nonproximal LAD occlusions for patients who had undergone an ECG within 180 minutes of symptom onset.\n\n\nResults: In this study, 72 patients had anterior STEMIs, with ECGs performed within 180 minutes of symptom onset. In patients who had undergone ECGs within 60 minutes (n¼35), the mean sum of ST elevation (STE) in leads V1 through V6 plus ST depression (STD) in leads II, III, and aVF was 19.2 mm for proximal LAD occlusions and 11.7 mm for nonproximal LAD occlusions (P¼0.007). A sum STE in V1 through V6 plus STD in II, III, and aVF of at least 17.5 mm had a sensitivity of 52.3%, specificity of 92.9%, positive predictive value of 91.7%, and negative predictive value of 56.5% for proximal LAD occlusions. When the ECG was performed more than 60 minutes after symptom onset (n¼37), there was no significant difference in ST-segment deviation between the 2 groups.\n\n\nConclusion: The sum STE (V1-V6) and STD (II, III, aVF) on a 12-lead ECG can be used to predict proximal LAD occlusions if performed within the first hour of symptom onset. This should be considered a high-risk finding and may prompt prehospital direction of such patients to PCI-capable hospitals. [West J Emerg Med. 2011;12(4):408–413.]","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial  4.0","short_name":"CC BY-NC 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc/4.0"},"keywords":[{"word":"electrocardiogram"},{"word":"ST elevation"},{"word":"myocardial infarction"},{"word":"proximal LAD"},{"word":"cardiology"},{"word":"Emergency Medicine"}],"section":"Cardiovascular","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6h6219bn","frozenauthors":[{"first_name":"Robert","middle_name":"A","last_name":"Aertker","name_suffix":"","institution":"University of Texas at Houston Medical School and Memorial Hermann Heart and Vascular Institute","department":"None"},{"first_name":"Colin","middle_name":"M","last_name":"Barker","name_suffix":"","institution":"University of Texas at Houston Medical School and Memorial Hermann Heart and Vascular Institute","department":"None"},{"first_name":"H","middle_name":"Vernon","last_name":"Anderson","name_suffix":"","institution":"University of Texas at Houston Medical School and Memorial Hermann Heart and Vascular Institute","department":"None"},{"first_name":"Ali","middle_name":"E","last_name":"Denktas","name_suffix":"","institution":"University of Texas at Houston Medical School and Memorial Hermann Heart and Vascular Institute","department":"None"},{"first_name":"Gregory","middle_name":"M","last_name":"Giesler","name_suffix":"","institution":"University of Texas at Houston Medical School and Memorial Hermann Heart and Vascular Institute","department":"None"},{"first_name":"Vinay","middle_name":"R","last_name":"Julapalli","name_suffix":"","institution":"University of Texas at Houston Medical School and Memorial Hermann Heart and Vascular Institute","department":"None"},{"first_name":"John","middle_name":"F","last_name":"Ledoux","name_suffix":"","institution":"University of Texas at Houston Medical School and Memorial Hermann Heart and Vascular Institute","department":"None"},{"first_name":"David","middle_name":"E","last_name":"Persse","name_suffix":"","institution":"Baylor College of Medicine, Department of Surgery, Houston, Texas; Houston Fire Department, Houston, Texas","department":"None"},{"first_name":"Stefano","middle_name":"","last_name":"Sdringola","name_suffix":"","institution":"University of Texas at Houston Medical School and Memorial Hermann Heart and Vascular Institute","department":"None"},{"first_name":"Mary","middle_name":"T","last_name":"Vooletich","name_suffix":"","institution":"University of Texas at Houston Medical School and Memorial Hermann Heart and Vascular Institute","department":"None"},{"first_name":"James","middle_name":"J","last_name":"McCarthy","name_suffix":"","institution":"University of Texas at Houston Medical School and Memorial Hermann Heart and Vascular Institute","department":"None"},{"first_name":"Richard","middle_name":"W","last_name":"Smalling","name_suffix":"","institution":"University of Texas at Houston Medical School and Memorial Hermann Heart and Vascular Institute","department":"None"}],"date_submitted":"2010-08-30T07:00:00Z","date_accepted":"2010-08-30T07:00:00Z","date_published":"2011-05-27T07:00:00Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18135/galley/9244/download/"}]}