Related Experiment Videos
Left anterior descending coronary artery obstruction. Clinical, electrocardiographic, and angiographic correlates
Insights
Severe left anterior descending coronary artery disease with anterior wall asynergy often shows electrocardiographic signs of myocardial infarction. Without asynergy, these signs are rare, with collateral circulation being more common in cases lacking infarction evidence.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Electrocardiography
Background:
- Severe occlusive left anterior descending (LAD) coronary artery disease is a critical condition.
- Anterior wall asynergy (akinesis or dyskinesis) can be present in patients with LAD disease.
- Electrocardiographic (ECG) findings and collateral circulation patterns require further elucidation in these patients.
Purpose of the Study:
- To investigate the relationship between severe LAD disease, anterior wall asynergy, and ECG characteristics of anterior myocardial infarction.
- To compare the incidence of clinically documented anterior myocardial infarction in patients with and without anterior wall asynergy.
- To examine the role of collateral circulation in LAD disease with and without anterior wall asynergy.
Main Methods:
- Coronary angiography was used to assess severe (greater than 80%) occlusive LAD disease in 76 patients.
- Patients were divided into two groups: Group A (59 patients) with anterior wall asynergy and Group B (17 patients) without.
- ECG characteristics, clinical history of anterior myocardial infarction, and collateral circulation to the LAD were analyzed.
Main Results:
- 64% of Group A patients showed ECG signs of anterior myocardial infarction, compared to 0% in Group B.
- 74.6% of Group A patients had documented previous anterior myocardial infarction.
- Collateral filling of the LAD was observed in 71% of Group A and 100% of Group B patients. Significantly higher collateral filling (93%) was noted in patients without definite ECG evidence of anterior myocardial infarction compared to those with (66%).
Conclusions:
- Severe LAD disease with anterior wall asynergy is typically associated with ECG evidence of anterior myocardial infarction.
- Equally severe LAD disease without anterior wall asynergy rarely presents with ECG abnormalities indicative of anterior myocardial infarction.
- Absence of ECG and angiographic evidence of anterior myocardial infarction in severe LAD disease often correlates with the presence of collateral circulation, which is less frequent when infarction is present.
Abstract:
Seventy-six patients with severe (greater than 80%) occlusive left anterior descending coronary artery disease by coronary angiography were examined for the electrocardiographic characteristics of this disease in the presence (group A 59 patients) or the absence (group B 17 patients) of anterior wall asynergy (akinesis or dyskinesis). The incidence of clinically documented anterior myocardial infarction in these two groups of patients was examined. The collateral circulation to the left anterior descending coronary artery was also examined in the groups of patients with and without anterior wall asynergy. Thirty-eight of 59 (64%) patients with anterior wall asynergy (group A) showed electrocardiographic signs of anterior myocardial infarction, 17 per cent showed probable electrocardiographic signs of anterior myocardial infarction and 19 per cent showed no electrocardiographic signs. None of the 17 patients without anterior wall asynergy (group B) showed electrocardiographic signs of anterior myocardial infarction. In group A 74.6 per cent had documented clinical evidence of previous anterior myocardial infarction. Collateral filling of the distal left anterior descending coronary artery was seen in 71 per cent of group A and 100 per cent of group B patients. There was a significantly higher incidence (P = 0.02) of collateral filling in the patients without electrocardiographic evidence of definite anterior myocardial infarction (93% of 28 patients), than in those who showed definite electrocardiographic evidence of anterior myocardial infarction (66% of 38 patients).it is concluded that severe occlusive left anterior descending coronary artery disease with anterior wall myocardial asynergy is usually associated with electrocardiographic signs of anterior myocardial infarction, whereas equally severe left anterior descending coronary artery disease without anterior wall asynergy is rarely associated with electrocardiographic abnormalities of anterior myocardial infarction. Severe left anterior descending coronary artery obstruction without electrocardiographic and angiographic evidence of anterior myocardial infarction is usually associated with collateral circulation to the left anterior descending coronary artery and collateral circulation to the left anterior descending coronary artery is present less frequently when obstruction is associated with anterior myocardial infarction.