Difference between Outcome of Left Circumflex Artery and Right Coronary Artery Related Acute Inferior Wall Myocardial Infarction in Patients Undergoing Adjunctive Angioplasty after Fibrinolysis

Sohrabi, Bahram; Separham, Ahmad; Madadi, Reza; Toufan, Mehrnoush; Mohammadi, Nasibeh; Aslanabadi, Naser; Kazemi, Babak

doi:10.5681/jcvtr.2014.022

Cited by 7 publications

(2 citation statements)

References 9 publications

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“…RCA je svojim granama kod 70% ljudi odgovorna za vaskularizaciju inferoposteriornog dela LK, međutim, kada je dominantan sistem LCA, vaskularizacija za taj deo srca dolazi iz LCx, odnosno varijacija njenih grana (OM1-OM3 ili varijacije zajedničkog stabla) [3]. Okluzija levog sistema koronarne vaskularizacije, ima lošiju prognozu kod inferiornog IM od okluzije u češćem desno-dominantnom sistemu [10].…”

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The dominant left coronary system occlusion: An ECG dilemma for Emergency physicians

Đorđević

2023

Halo 194

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Introduction/Objective Acute chest pain is the main clinical manifestation of acute coronary syndrome. A posterior myocardial infarction (MI) most commonly occurs as a complication or extension of an inferior MI because of the overlapping coronary vascularization. We are presenting a case in which the patient exhibited mild anginal symptoms and an ECG pattern which did not correlate with a devastating infarction. Case report: The Emergency Medical Team (EMT) was dispatched at 5 am to help a 62-year-old patient, who had been woken from his sleep by a feeling of tightness in his chest and weakness in both arms. Upon examination, the patient was hypertensive (160/90 mmHg) and moderately bradycardic (58-62/min), with normal oxygen saturation on room air (SaO2 98%). His prehospital ECG findings were as follows: sinus rhythm, horizontal ST depression in V1-V3 1 to 2mm, ST elevation ≤1mm in lead V6, subtle ST depression in D1 and aVL <1mm, ST elevation in D3 and aVF <1mm. After attaching additional posterior leads, the modified ECG recording showed an ST elevation of 1 to 2 mm in V7-V9. Continuous laboratory monitoring of cardiac enzyme markers showed elevated and increasing values: Troponin T -2377, 3756 ng/l; CK -1572, 1564 U/l. Coronary angiography: The LCA system was dominant. The RCA was nondominant with a 70-80% stenosis, and a complete Occlusion Myocardial Infarction (OMI) distally. Using the most accurate LCxc/RCA occlusion algorithms, the ECG finding suggested an occlusion in the right dominant coronary system, which does not correlate with the coronary angiography report. Conclusion: Excellent knowledge of recording, analysis, and interpretation of ECG tracings, facilitates adequate pre-hospital care and precise planning for further processing of patients with chest pain. It is recommended to record posterior and right unipolar leads in all patients with inferior and suspicion of posterior myocardial infarctions and to include the ST-elevation myocardial infarction equivalent into the STEMI network. Given the physiological differences in left ventricular vascularization and the possible predominance of the left coronary system over the right, future studies must focus on establishing more precise algorithms for assessing RCA/LCx occlusion.

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Section: Diskusijaunclassified

The dominant left coronary system occlusion: An ECG dilemma for Emergency physicians

Đorđević

2023

Halo 194

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“…In the NSTEMI subgroup, recommendations are not so strict and depend upon the clinical and hemodynamic condition of the patient [2]. Moreover, among MI patients, those with an occluded or critically stenosed left circumflex (LCx) coronary artery seem to be the most challenging group to identify and immediately qualify for urgent angiography due to non-conclusive ECG changes on admission and confusing clinical presentation [3][4][5][6][7][8][9][10][11]. Our investigation has gone further, and we focused on assessing whether a different localization of the culprit plaque (proximal vs. medial vs. distal segment) within the circumflex artery responsible for MI has any implications on procedural aspects and clinical outcomes for these patients.…”

Section: Introductionmentioning

confidence: 99%

Culprit plaque location within the left circumflex coronary artery predicts clinical outcomes in patients experiencing acute coronary syndromes with percutaneous coronary intervention: Data from the ORPKI registry

et al. 2022

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Background:The left circumflex (LCx) artery is the most diagnostically challenging of the coronary branches in terms of diagnostics because the clinical presentation and electrocardiography (ECG) do not always suggest critical occlusion despite its presence. Therefore, it is important to determine the factors contributing to the clinical manifestation and outcome, such as the culprit location. Aims:To determine the relationship between the location of the culprit plaque and clinical outcomes in the LCx artery.Methods: Data from the Polish Registry of Invasive Cardiology Procedures (ORPKI) from the years 2019-2020 concerning percutaneous coronary intervention (PCI) procedures were extracted and analyzed using appropriate statistical tests.Results: 97 899 clinical records were analyzed. Patients with proximal occlusion received a worse grade using the Killip classification. Patients with Thrombolysis in Myocardial Infarction (TIMI) score 0 had worse clinical presentation in each of the occlusion locations. The periprocedural cardiac arrest and death rates were the highest among patients with proximal circumflex (Cx) occlusion. The death rate among patients with proximal occlusion and non-ST-segment elevation myocardial infarction (NSTEMI) was greater than among patients with distal occlusion and ST-segment elevation myocardial infarction (STEMI).Conclusions: Among patients with proximal occlusions of the Cx artery and TIMI 0 grade flow on initial angiogram, a STEMI-like approach should be undertaken apart from initial ECG findings. This is driven by a higher rate of critical and fatal complications such as cardiac arrest and periprocedural death. Fatal complications occur more often in patients with proximal occlusion of Cx than in medial or distal occlusion. Grade IV according to the Killip classification can suggest a proximal culprit location.

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Effect of infarct site on the clinical endpoints of thrombolytic-treated ST-elevation myocardial infarction

Gifft

Dohrmann

Eniezat

et al. 2020

The American Journal of Emergency Medicine

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Difference between Outcome of Left Circumflex Artery and Right Coronary Artery Related Acute Inferior Wall Myocardial Infarction in Patients Undergoing Adjunctive Angioplasty after Fibrinolysis

Cited by 7 publications

References 9 publications

The dominant left coronary system occlusion: An ECG dilemma for Emergency physicians

The dominant left coronary system occlusion: An ECG dilemma for Emergency physicians

Culprit plaque location within the left circumflex coronary artery predicts clinical outcomes in patients experiencing acute coronary syndromes with percutaneous coronary intervention: Data from the ORPKI registry

Effect of infarct site on the clinical endpoints of thrombolytic-treated ST-elevation myocardial infarction

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