Modified Occlusion Myocardial Infarction Electrocardiographic Criteria

Öz

The electrocardiogram (ECG) is a useful diagnostic tool that allows clinicians to rapidly evaluate patients for acute coronary syndrome. The EKG is crucial in the evaluation of chest pain and diagnosis of ischemia. It is critical for clinicians to be able to accurately recognize these ischemic patterns to allow timely and appropriate cardiovascular care. The classic ST-segment elevation myocardial infarction (STEMI) with rapid reperfusion within less than 60 minutes of acute coronary occlusion improve morbidity and decrees mortality. According to the Fourth Universal Definition of Myocardial Infarction, the STEMI criteria consist of (1) 1 mm ST-segment elevation in any 2 consecutive leads at the J point, excluding V2 and V3; and (2) age- and sex-specific ST-segment elevation thresholds in V2 and V3 (1.5 mm elevation in women regardless of age, 2.5 mm in men <40 years, and 2mminmen aged 40 years), in the absence of left ventricular hypertrophy and bundle branch block (1), but despite that approximately half of high-risk patients with occlusion myocardial infarction fail to meet STEMI criteria, resulting in delays in urgent revascularization (2,3) Definition of occlusion myocardial infarction representing near or total occlusion of a culprit epicardial coronary artery with insufficient collateral circulation causing active infarction, thus necessitating emergency reperfusion (4) In this review we detail the high-risk ECG occlusion myocardial infarction patterns indicative of acute myocardial ischemia resulting from active totally or near totally occlusion of coronary artery

Anahtar Kelimeler

• ELECTROCARDIOGRAPHIC
• myocardial ınfarction
• NEW PATTERN

EKG ve akut myokard infarktüs - Derleme

Öz

Tipik ST elevasyonlu olmayan, miyokard infarktüs geçiren hastalar , bir sürü yeni kriterler sunmaktayız bu derlemede.

Anahtar Kelimeler

• ELEKTROKARDİYOGRAFİ
• MİYOKARD İNFARKTÜS
• YENİ KRİTERLER

Kaynakça

1. 1. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Circulation. 2018;138:e618-e651.
2. 2. . de Alencar Neto JN, Scheffer MK, Correia BP, et al. Systematic review and meta-analysis of diagnostic test accuracy of ST-segment elevation for acute coronary occlusion. Int J Cardiol. 2024;402: 131889.
3. 3. Meyers HP, Bracey A, Lee D, et al. Comparison of the ST-elevation myocardial infarction (STEMI) vs. NSTEMI and occlusion MI (OMI) vs. NOMI paradigms of acute MI. J Emerg Med. 2021;60:273-284.
4. 4. Meyers HP, Bracey A, Lee D, et al. Accuracy of OMI ECG findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction. Int J Cardiol Heart Vasc. 2021;33:100767.
5. 5. H. Pendell Meyers, Franti sek Siman, Robert Herman.Et al. Hyperacute T Waves Are Specific for Occlusion Myocardial Infarction, Even Without Diagnostic ST-Segment Elevation.JACC Adv. 2025;4:102120.
6. 6. Sgarbossa EB, Pinski SL, Barbagelata A, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators. N Engl J Med 1996;334:481-7. 3.
7. 7. Smith SW, Dodd KW, Henry TD, Dvorak DM, Pearce LA. Diagnosis of ST-elevation myocardial infarction in the presence of left bundle branch block with the ST-elevation to S-wave ratio in a modified Sgarbossa rule. Ann Emerg Med 2012;60:766-76
8. 8. Andrea Di Marco,Marcos Rodriguez,Juan Cinca et al. New Electrocardiographic Algorithm for the Diagnosis of Acute Myocardial Infarction in Patients With Left Bundle Branch Block. J Am Heart Assoc. 2020;9:e015573.

9. 9. Mohammed Habib. Electrocardiographic Criteria for Diagnosis of Acute Myocardial Infarction in Patients with Left Bundle Branch Block. Eurasian Journal of Critical Care. 2024;6(2): 88-90
10. 10. de Zwaan C, Bar FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J. 1982 Apr. 103(4 Pt 2):730-6
11. 11. Rhinehardt J, Brady WJ, Perron AD, Mattu A. Electrocardiographic manifestations of Wellens' syndrome. Am J Emerg Med 2002;20(7):638–43. [5]
12. 12. Nisbet BC, Zlupko G. Repeat Wellens' syndrome: case report of critical proximal left anterior descending artery restenosis. J Emerg Med 2010;39(3):305–8.
13. 13. de Winter RJ, Verouden NJ, Wellens HJ, Wilde AA, Interventional Cardiology Group of The Academic Medical Center. A new ECG sign of proximal LAD occlusion. N Engl J Med. 2008;359:207 1-3.
14. 14. Mills RM, Young E,Gorlin R, Lesch M. Natural historyof S-T segment elevation after acute myocardial infarction.A m J Cardiol 1975;35:609–14.
15. 15. ] Berger AK,Radford MJ,Wang Y,Krumholz HM.Thrombolytic therapy in older patients. Jam Coll Cardiol 2000;36:366–74.
16. 16. Lauren R. Klein ,Gautam R. Shroff, William Beeman, , Stephen W. Smith, Electrocardiographic criteria to differentiate acute anterior ST-elevation myocardial infarction from left ventricular aneurysm. American Journal of Emergency Medicine 33 (2015) 786–790
17. 17. Miranda DF, Lobo AS, Walsh B, et al. New insights into the use of the 12-lead electrocardiogram for diagnosing acute myocardial infarction in the emergency department. Can J Cardiol 2018 Feb;34(2):132-145
18. 18. Ehrin J. Armstrong, MSca, Ameya R. Kulkarni, Electrocardiographic Criteria for ST-Elevation Myocardial Infarction in Patients With Left Ventricular Hypertrophy. Am J Cardiol 2012;110:977–983
19. 19. Emre Aslanger, OzlemYıldırımtürk, Barış Şimşek, et al. A newelectrocardiographic pattern indicating inferior myocardial infarction. Journal of Electrocardiology 61 (2020) 41–46
20. 20. Steven Swarath , Nicole Maharaj , Andrew Hall , Jean Marie Frederick. The South African Flag Sign: An Electrocardiographic Flag for All Coronary Territories? J Investig Med High Impact Case Rep 2023 Aug 9;11:23247096231192861.
21. 21. Frink RJ, James TN. Normal blood supply to the human his bundle and proximal bundle branches. Circulation. 1973;47:8-18.
22. 22. Lucas Goss, Pendell Meyers, Alexander Bracey, et al. Precordial swirl sign: A new ECG pattern of left anterior descending artery occlusion myocardial infarction. Journal of Electrocardiology 91 (2025) 153931
23. 23. Nikus K, Birnbaum Y, Eskola M, et al. Updated electrocardiographic classification of acute coronary syndromes. Curr Cardiol Rev. 2014;10:229–236.
24. 24. Lee DH, Walsh B, Smith SW. Terminal QRS distortion is present in anterior myocardial infarction but absent in early repolarization. Am J Emerg Med. 2016;34:2182–2185.
25. 25. Mulay DV, Mukhedkar SM. Prognostic significance of the distortion of terminal portion of QRS complex on admission electrocardiogram in ST segment elevation myocardial infarction. Indian Heart J. 2013;65:671–677. doi: 10.1016/j.ihj.2013.10.012.
26. 26. Birnbaum Y, Herz I, Sclarovsky S, et al. Prognostic significance of the admission electrocardiogram in acute myocardial infarction. J Am Coll Cardiol. 1996;27:1128–1132.
27. 27. Agarwal J, Khaw K, Aurignac F, et al. Importance of posterior chest leads in patients with suspected myocardial infarction, but nondiagnostic, routine 12-lead electrocardiogram. Am J Cardiol 1999;83:323-6.
28. 28. Namana V, Balasubramanian R,HollanderG.A71-Year-Old Man With Complicated Myocardial Infarction. JAMACardiol 2016;1(6):735–6.
29. 29. Carroll R, Sharma N, Butt A, Hussain KM.Unusual electrocardiographic presentation of an isolated right ventricular myocardial infarction secondary to thrombotic occlusion of anon-dominant right coronary artery.Angiology 2003;54(1):119–24.