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Magnitude and consequences of missing the acute infarct-related circumflex artery

Amar Krishnaswamy1, A Michael Lincoff, Venu Menon

  • 1Cleveland Clinic Division of Cardiovascular Medicine, OH 44195, USA. krishna2@ccf.org

American Heart Journal
|October 27, 2009
PubMed

Insights

Many acute myocardial infarctions involving the left circumflex artery are missed due to electrocardiogram insensitivity. This delay in diagnosing left circumflex artery occlusion leads to worse cardiovascular outcomes.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Emergency Medicine

Background:

  • Reperfusion strategies are key for acute coronary artery occlusion outcomes.
  • ST-segment elevation myocardial infarction (STEMI) diagnosis relies on electrocardiograms (ECG), which can miss posterior circulation occlusions.
  • Non-STEMI studies show delayed angiography, and STEMI studies reveal underrepresentation of the left circumflex artery as the infarct-related artery.

Purpose of the Study:

  • To review the incidence and consequences of missed left circumflex artery occlusions in myocardial infarction.
  • To discuss ECG findings indicative of left circumflex artery occlusion.
  • To highlight strategies for improving early identification of these "missed" infarcts.

Main Methods:

  • Literature review focusing on missed left circumflex artery occlusions.
  • Analysis of diagnostic disparities in acute coronary syndromes.
  • Review of ECG findings and diagnostic strategies.

Main Results:

  • A significant number of myocardial infarctions may be attributed to left circumflex artery occlusion but are initially missed.
  • The posterior territory, supplied by the left circumflex artery, is often electrocardiographically silent.
  • Delayed diagnosis of left circumflex artery occlusion results in delayed myocardial salvage and poorer patient outcomes.

Conclusions:

  • Enhanced awareness of left circumflex artery occlusion is crucial for improving acute myocardial infarction patient outcomes.
  • Utilizing specific ECG findings and diagnostic strategies can help avoid missing these critical diagnoses.
  • Prompt identification and reperfusion are imperative for patients with left circumflex artery occlusion.

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