Total occlusion of the left main coronary artery presenting as ST-elevation myocardial infarction

Area of Science:

• Cardiology
• Medical Diagnostics

Background:

• The electrocardiogram (ECG) is crucial for diagnosing myocardial infarction.
• Left main (LM) coronary artery occlusion is a critical condition often presenting with distinct ECG findings.

Observation:

• A specific ECG pattern (widespread ST depression with ST elevation in aVR/V1) is typically associated with non-ST-segment elevation myocardial infarction (NSTEMI) due to LM subocclusion or occlusions with collateral circulation.
• This ECG pattern is rarely reported in cases of ST-elevation myocardial infarction (STEMI) due to acute total LM occlusion.

Findings:

• This report details a case of STEMI presenting with an acute total LM occlusion.
• The observed ECG pattern, typically linked to NSTEMI, was found in a patient with acute total LM occlusion, challenging previous diagnostic associations.

Implications:

• The findings suggest that the described ECG pattern may not exclusively indicate NSTEMI in LM artery occlusion.
• This highlights the need for careful interpretation of ECG findings in suspected acute coronary syndromes involving the LM artery.
• Clinicians should consider STEMI due to acute total LM occlusion even with this seemingly typical NSTEMI ECG pattern.