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To evaluate whether the site of occlusion/stenosis in the left anterior descending coronary artery (LAD) could be diagnosed by noninvasive techniques, thallium-201 myocardial scintigraphy (TMS), 12-lead electrocardiography (ECG), and coronary arteriography were performed in 33 patients with anterior acute myocardial infarction (AMI). The subjects were divided into two groups according to the location of stenosis: ie, either proximal to the first diagonal branch (PRO, n = 18), or beyond the first diagonal branch (NON-PRO, n = 15). The location of the anterior interventricular groove was defined as 0 degrees. The extent of persistent perfusion defect was greater in the PRO group than in the NON-PRO group (0.43 +/- 0.12 vs 0.31 +/- 0.14, p &lt; 0.01). The left margin of the defect in the basal short-axis layer was at 75 +/- 30 degrees in the PRO group and at -19 +/- 43 degrees in the NON-PRO group (p &lt; 0.001). A defect with a left margin at &gt; 30 degrees in the basal layer was found in 94% (17/18) of the patients in the PRO group and in 6% (1/15) of the patients in the NON-PRO group (p &lt; 0.001). An abnormal Q wave in leads a VL/I was found in 78% (14/18) of the patients in the PRO group and in 20% (3/15) of the patients in the NON-PRO group (p &lt; 0.001). The sensitivity, specificity and total predictive accuracy of detection of proximal lesions of the LAD were 94%, 93% and 94% by TMS, and 78%, 80% and 79% by ECG, respectively. A significant difference in accuracy existed between TMS and ECG (p &lt; 0.05). These data suggest that it is possible to diagnose the site of occlusion/stenosis of the LAD as either proximal or non-proximal in patients with anterior AMI by TMS and ECG.

japanese circulation journal

Diagnosis of Occlusion Site in the Left Anterior Descending Coronary Artery in Patients with Anterior Myocardial Infarction. Comparison of Thallium-201 Myocardial Scintigraphy and 12-Lead Electrocardiography.