Echocardiographic prediction of the site of coronary artery obstruction in acute myocardial infarction

In 49 patients with acute myocardial infarction (AMI), the infarctiontopography was assessed by cross-sectional echocardiographyand the location of coronary artery obstruction were correlated.A ventricular segmentation of 5 right and 16 left ventricularsegments was used. The site of coronary obstruction was determinedin 45 patients by coronary angiography and by necropsy in 4patients. The exact location of the obstruction could not befound in 4 patients. The infarct related vessel was the leftmain artery in 1 patient, the left anterior descending artery(LAD) in 19, the left circumflex in 6 and the right coronaryartery in 24.Specific segments were identified for each of the3 coronary arteries: anteroseptal and anterior segments forLAD, right ventricular segments for the right coronary arteryand basal anterolateral segment for the left circumflex. Specificsegments (specificity 100%) were also identified for the principalcoronary branches: basal anterior for the first anterior descendingdiagonal (sensitivity 71%), basal anteroseptal for the firstseptal perforator (83%), middle anterior for the second diagonal(100%), middle anteroseptal for the second septal (89%), basalposteroseptal for a dominant right coronary artery (89%), rightventricular anterolateral segment for the right ventriclar marginalbranch (83%) Echocardiographic identification of the topography of AMI canbe useful in recognizing the infarct-related vessel and identifyingthe site of coronary artery obstruction.