USEFULNESS OF THE ADMISSION ELECTROCARDIOGRAM FOR IDENTIFYING THE INFARCT-RELATED ARTERY IN INFERIOR WALL ACUTE MYOCARDIAL-INFARCTION

Abnormalities in the electrocardiogram (ECG) are frequently used to pr edict the infarct-related artery (IRA) in patients with acute myocardi al infarction (AMI). Whereas inferior ST-segment elevation occurring d uring AMI usually indicates occlusion of the right coronary artery, le ss often the left coronary artery (LC) or rarely the left anterior des cending (LAD) artery may be the cause. Because of the limitations of t he ECG and the posterior distribution of the LC, occlusion of this art ery infrequently results in diagnostic ST-segment elevation,(1,2) and inferior ST-segment elevation occurs <50% of the time.(3) Criteria for determining the IRA based on the initial ECG in patients with inferio r wall AMI have not been well described. This study compares the initi al ECG with coronary angiographic findings in patients having electroc ardiographic criteria for inferior wall AMI in order to determine whet her the initial ECG can predict the IRA and whether the extent of coro nary artery disease alters the ability to predict the culprit artery.