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A new and modified northern occlusion myocardial infarction pattern

Honglin Ni1, Xiao Wan1, Ting Shi1

  • 1Department of Electrocardiology, Affiliated Hospital of Jiaxing University, Jiaxing 314001, China.

Journal of Electrocardiology
|February 20, 2026
PubMed

Insights

Identifying atypical occlusive myocardial infarction (OMI) is difficult. This study suggests modified ECG criteria for Northern OMI, using ST-segment elevation in aVR/aVL with reciprocal depression in II, III, and aVF.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Electrocardiography

Background:

  • Atypical occlusive myocardial infarction (OMI) presents diagnostic challenges in clinical practice.
  • The recently proposed Northern occlusive myocardial infarction (Northern OMI) requires further definition.
  • Electrocardiogram (ECG) findings are crucial for diagnosing myocardial infarction.

Purpose of the Study:

  • To analyze potential ECG manifestations of Northern OMI in acute coronary syndrome (ACS).
  • To investigate associated coronary artery vessel types in Northern OMI.
  • To propose modified diagnostic criteria for Northern OMI.

Main Methods:

  • Retrospective analysis of 9 patients with ST-segment elevation (STE) in leads aVR and aVL.
  • Exclusion of patients with typical ST-segment elevation occlusive myocardial infarction (STE-OMI) ECG criteria.
  • Coronary angiography to identify culprit coronary artery lesions.

Main Results:

  • Eight of nine patients were diagnosed with OMI, involving single or multivessel lesions.
  • Seven patients received timely coronary intervention; one opted for conservative treatment.
  • One case was attributed to acute brainstem hemorrhage.

Conclusions:

  • Current diagnostic models for Northern OMI may be limited.
  • Proposed modified criteria: STE in aVR and aVL with reciprocal ST-segment depression (STD) in leads II, III, and aVF.
  • These findings may improve the identification of atypical OMI.
Abstract

Keywords:
Acute cerebral hemorrhageLeft main coronary artery diseaseMultivessel diseaseOcclusive myocardial infarctionST-segment elevation in leads aVR and aVL

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