Electrocardiographic presentations of acute total occlusion of the left main coronary artery

摘要

In this issue of the Journal, Fiol et all present a small series of ST-elevation myocardial infarction (STEMI) patients with sudden total occlusion of the left main coronary artery (LMCA) and describe the electrocardiographic (ECG) changes observed in the acute stage. The LMCA refers to the proximal segment of the left coronary artery that arises from the left coronary sinus to its bifurcation into the left anterior descending (LAD) and left circumflex (LCx) arteries. In most individuals, the LMCA supplies approximately 75% of the left ventricular myocardial mass. In individuals with left-dominant coronary artery circulation, almost the entire left ventricular myocardial mass may be supplied by the LMCA. Total or subtotal occlusion with impaired coronary flow of the LMCA, especially in acute coronary syndrome (ACS), places the patient at risk for life-threatening left ventricular dysfunction and malignant arrhythmias.