Abstract
Background
Little is known about the relationship between the electrocardiographic characteristics
and the infarct related artery (IRA) in non-ST-elevation myocardial infarction (NSTEMI).
We found a curious phenomenon in electrocardiograms of patients with acute occlusion
of left circumflex artery in NSTEM: A notch or deflection was often present in the
terminal QRS complex in leads II,III and aVF or I,aVL . The objective of this study
was to determine whether the previously unreported ECG phenomenon that we have found
in NSTEMI could identify the culprit artery in non-ST-elevation myocardial infarction.
Methods and Results
Our study included 218 NSTEMI patients who presented to our institution and underwent
coronary angiography within 24 hours of admission. For convenience, ‘N’ wave was defined as a notch or deflection in the terminal QRS complex of the surface
ECG. The duration of QRS with N wave before PCI was more prolonged than the duration of QRS without N wave (121±12 ms vs 106±11 ms, P<0.01). In the LCX group, 66(77%) patients had N wave in leads II, III and aVF, whereas only 5(6%) patients in the LAD group and 9(18%)
patients in the RCA group had such ECG feature (P<0.001). A greater proportion of patients in the LCX group also had N waves in leads I and aVL (P<0.001). N wave in leads II, III and aVF was associated with 77% sensitivity and 89% specificity,
respectively. N wave in leads I and aVL was associated with 64% sensitivity and 96% specificity,
respectively.
Conclusion
The abnormal waveform in terminal QRS complex in NSTEMI ,which is described above,
is the delayed activation wave of left ventricular basal region which the left circumflex
artery supplies. It is associated with a higher specificity and higher sensitivity
for culprit LCX in non-ST-elevation myocardial infarction. The delayed activation
wave is a new pattern of ischemia in ECG.
Keywords
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Article info
Publication history
Published online: June 10, 2011
Accepted:
May 13,
2011
Received in revised form:
March 1,
2011
Received:
October 13,
2010
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
