Kurisu et al identified changes in the electrocardiogram that were associated with 30 day mortality for a patient with an acute myocardial infarction (AMI) following occlusion of the left main coronary artery (LMCA). The authors are from Hiroshima City Hospital in Hiroshima, Japan.


Exclusions: history of previous AMI, left ventricular hypertrophy, left bundle branch block (LBBB) and occlusion of the right coronary artery >= 75%


Changes in the ECG associated with 30-day mortality following LMCA AMI:

(1) ST segment elevation >= 0.1 mV in aVR AND ST segment elevation >= 0.1 mm in aVL

(2) ST segment depression >= 0.1 mV in V5

(3) left anterior fascicular block (LAFB)

(4) right bundle branch block (RBBB)



• ST segment elevation in aVR and aVL suggests transmural ischemia over a large area supplied by the left anterior descending (LAD) artery.

• ST segment depression in V5 is associated with LAD occlusion proximal to the first septal branch.


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