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ST-segment elevation in leads I and aVL predicts short-term prognosis in acute anterior wall myocardial infarction

      Prognosis after acute myocardial infarction (AMI) is influenced by the size of the ischemic area, with a larger infarct portending a worse prognosis.
      • Clements I.P
      • Kaufmann U.P
      • Bailey K.R
      • Pellikka P.A
      • Behrenbeck T
      • Gibbons R.J
      Electrocardiographic prediction of myocardial area at risk.
      ,
      • Christian T.F
      • Gibbons R.J
      • Clements I.P
      • Berger P.B
      • Selvester R.H
      • Wagner G.S
      Estimates of myocardium at risk and collateral flow in acute myocardial infarction using electrocardiographic indexes with comparison to radionuclide and angiographic measures.
      We previously reported that chronic left ventricular function after an anterior wall infarction was reduced if the infarct-related lesion was proximal to the first diagonal branch of the left anterior descending coronary artery.
      • Yoshino H
      • Taniuchi M
      • Kachi E
      • Shimizu H
      • Kajiwara T
      • Ohguchi M
      • Okada M
      • Ishikawa K
      Asynergy of the noninfarcted left ventricular inferior wall in anterior wall acute myocardial infarction secondary to isolated occlusion of the left anterior descending artery.
      Acute occlusion of the left anterior descending coronary artery proximal to its first diagonal branch is characterized by ST elevation in the precordial leads as well as in leads I and aVL,
      • Griffith L.S
      • Platia E.V
      • Angell C.S
      • Grunwald L
      Coronary arteriographic and electrocardiographic correlates of sudden cardiac death.
      and tends to be pathologically extensive.
      • Schuster E.H
      • Griffith L.S
      • Bulkley B.H
      Preponderance of acute proximal left anterior descending coronary arterial lesions in myocardial infarction a clinicopathologic study.
      Anterior wall infarctions are usually larger than inferior and lateral wall infarctions, and have a substantially worse prognosis.
      • Molstad P
      Prognostic significance of type and location of a first myocardial infarction.
      ,
      • Stone P.F
      • Raabe D.S
      • Jaffe A.S
      Prognostic significance of location and type of myocardial infarction independent adverse outcome associated with anterior location.
      Acute reperfusion therapy has been demonstrated to be more effective in anterior than inferior wall infarctions.
      GUSTO Investigators
      An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction.
      The relation between prognosis and the presence of ST elevation in leads I and aVL on the admission 12-lead electrocardiogram in patients with an anterior AMI has not been evaluated. The aim of the present study was to investigate whether ST elevation in leads I and/or aVL is an independent predictor of prognosis in patients presenting with an anterior AMI.
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      References

        • Clements I.P
        • Kaufmann U.P
        • Bailey K.R
        • Pellikka P.A
        • Behrenbeck T
        • Gibbons R.J
        Electrocardiographic prediction of myocardial area at risk.
        Mayo Clin Proc. 1991; 66: 985-990
        • Christian T.F
        • Gibbons R.J
        • Clements I.P
        • Berger P.B
        • Selvester R.H
        • Wagner G.S
        Estimates of myocardium at risk and collateral flow in acute myocardial infarction using electrocardiographic indexes with comparison to radionuclide and angiographic measures.
        J Am Coll Cardiol. 1995; 26: 388-393
        • Yoshino H
        • Taniuchi M
        • Kachi E
        • Shimizu H
        • Kajiwara T
        • Ohguchi M
        • Okada M
        • Ishikawa K
        Asynergy of the noninfarcted left ventricular inferior wall in anterior wall acute myocardial infarction secondary to isolated occlusion of the left anterior descending artery.
        Am J Cardiol. 1998; 81: 828-833
        • Griffith L.S
        • Platia E.V
        • Angell C.S
        • Grunwald L
        Coronary arteriographic and electrocardiographic correlates of sudden cardiac death.
        Acta Med Scand Suppl. 1977; 615: 43-46
        • Schuster E.H
        • Griffith L.S
        • Bulkley B.H
        Preponderance of acute proximal left anterior descending coronary arterial lesions in myocardial infarction.
        Am J Cardiol. 1981; 47: 1189-1196
        • Molstad P
        Prognostic significance of type and location of a first myocardial infarction.
        J Intern Med. 1933; 233: 393-399
        • Stone P.F
        • Raabe D.S
        • Jaffe A.S
        Prognostic significance of location and type of myocardial infarction.
        J Am Coll Cardiol. 1988; 11: 453-463
        • GUSTO Investigators
        An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction.
        N Engl J Med. 1993; 329: 679-682
        • Chesebro J.H
        • Knatterud G
        • Roberts R
        • Borer J
        • Cohen L.S
        • Daren J
        Thrombolysis in Myocardial Infarction (TIMI) trial, phase 1.
        Circulation. 1987; 76: 142-154
        • Hands M.E
        • Rutherford J.D
        • Muller J.E
        The in-hospital development of cardiogenic shock after myocardial infarction.
        J Am Coll Cardiol. 1989; 14: 40-46
        • Kudenchuk P.J
        • Maynard C
        • Martin J.S
        • Wirkus M
        • Weaver D
        • MITI Project Investigators
        Comparison of presentation, treatment, and outcome of acute myocardial infarction in men versus women (the myocardial infarction triage and intervention registry).
        Am J Cardiol. 1996; 78: 9-14
        • Mukharji J
        • Rude P.E
        • Poole K
        Risk factors for sudden death following acute myocardial infarction.
        Am J Cardiol. 1984; 54: 31-35
        • Bigger J.T
        • Dresdale R.J
        • Heissenbuttel R.H
        Ventricular arrhythmias in ischemic heart disease.
        Prog Cardiovasc Dis. 1977; 19: 255-258
        • Birnbaum Y
        • Herz I
        • Sclarousky S
        • Blum A
        • Mager A
        • Gabbay U
        Prognostic significance of precordial ST-segment depression on admission electrocardiogram in patients with inferior wall myocardial infarction.
        J Am Coll Cardiol. 1996; 28: 313-318
        • Edmunds J.J
        • Gibbons R.J
        • Bresnahan J.F
        • Clements I.P
        Significance of anterior ST depression in inferior wall acute myocardial infarction.
        Am J Cardiol. 1994; 73: 143-148
        • Birnbaum Y
        • Herz I
        • Sclarousky S
        • Blum A
        • Mager A
        • Gabbay U
        Prognostic significance of the initial electrocardiographic pattern in a first acute anterior wall myocardial infarction.
        Chest. 1993; 103: 1681-1687
        • Aldrich H.R
        • Wagner N.B
        • Boswick J
        Use of initial ST-segment deviation for prediction of final electrocardiographic size of acute myocardial infarcts.
        Am J Cardiol. 1988; 61: 749-753
        • Nielsen B.L
        ST-segment elevation in acute myocardial infarction.
        Circulation. 1973; 48: 338-345
        • Tamura A
        • Kataoka H
        • Nagase K
        • Mikuriya Y
        • Nasu M
        Clinical significance of inferior ST elevation during acute myocardial infarction.
        Br Heart J. 1995; 74: 611-614
        • ISIS-2 (Second International Study of Infarct Survival) Collaborative Group
        Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction.
        Lancet. 1988; 2: 349-360