Document Detail

Magnitude and consequences of missing the acute infarct-related circumflex artery.
MedLine Citation:
PMID:  19853686     Owner:  NLM     Status:  MEDLINE    
Emergent reperfusion strategies are integral to providing optimal patient outcomes in the setting of acute coronary artery occlusion. ST-segment elevation on the surface 12-lead electrocardiogram, although specific as a surrogate marker, is insensitive to acute posterior circulation coronary artery occlusion. Studies of non-ST-segment elevation acute coronary syndrome consistently identify patients who have epicardial vessel occlusion at the time of initial angiography, which is usually delayed for hours or days after the initial presentation. In addition, studies of ST-segment elevation myocardial infarction often divulge a disparity in identification of the infarct-related artery, with an underrepresentation of the left circumflex artery. Taken together, it is likely that many patients with left circumflex artery occlusion are "missed" during the early phases of myocardial infarction due to the electrocardiographically silent nature of the posterior territory, resulting in delayed myocardial salvage and worse cardiovascular outcomes. In this review, we report on the magnitude of missed left circumflex infarction and the consequences of this delay in diagnosis. We review the electrocardiographic findings of left circumflex occlusion and discuss strategies to enhance early identification. Heightened awareness of this clinical scenario and the available methods to avoid missing this elusive diagnosis are imperative in our quest to further improve the outcomes of patients with acute myocardial infarction.
Amar Krishnaswamy; A Michael Lincoff; Venu Menon
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2009-09-24
Journal Detail:
Title:  American heart journal     Volume:  158     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-26     Completed Date:  2009-12-31     Revised Date:  2010-07-07    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  706-12     Citation Subset:  AIM; IM    
Cleveland Clinic Division of Cardiovascular Medicine, OH 44195, USA.
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MeSH Terms
Coronary Angiography
Coronary Circulation
Coronary Occlusion / complications*,  diagnosis*
Myocardial Infarction / diagnosis*,  etiology*
Comment In:
Am Heart J. 2010 Jul;160(1):e5; author reply e7   [PMID:  20598962 ]

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