Prediction of the site of total occlusion in the left anterior descending coronary artery using admission electrocardiogram in anterior wall acute myocardial infarction

In conclusion, in anterior AMI, ST elevation in aVL and ST depression in II, III, and aVF predict a culprit lesion in the LAD proximal to the origin of the first diagonal branch, with a good specificity and positive predictive value (positive predictive value in a group of heterogeneous patients at a sample size of 64 has significant limitations and needs to be examined in a large group of patients such as the GUSTO-I study to put more validity to this observation). In anterior AMI, the most important coronary anatomic determinant of inferior ST depression appears to be the site of LAD occlusion. Inferior ST depression is not related to remote ischemia, but represents an electrocardiographic phenomenon reciprocal to ST elevation in aVL; this ST elevation in aVL is related to anterolateral extension of the infarct secondary to first diagonal branch ischemia. Because inferior ST depression predicts a proximal LAD occlusion and a proximal LAD occlusion is associated with greater infarct size, this would explain the association of inferior ST depression with greater infarct size, left ventricular dysfunction, and poorer prognosis in anterior AMI.