ArticleJournal of the American Heart Association2021
Ischemic ST-Segment Depression Maximal in V1-V4 (Versus V5-V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia).
Article in Journal of the American Heart Association, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 43 citations in OpenAlex.
- Thrombolysis in non-ST-elevation myocardial infarction: systematic review and meta-analysis of randomised controlled trials.Open heart · 2025Pooled it
- From Electrocardiography to the Catheterization Laboratory: A Multimodal Artificial Intelligence Framework for Acute Coronary Syndrome Detection and Risk Stratification.Diagnostics (Basel, Switzerland) · 2026Review
- Acute Coronary Occlusion in NSTEMI Patients: Prevalence, Clinical Characteristics and the Potential Role of Artificial Intelligence.Medicina (Kaunas, Lithuania) · 2026Article
- Detecting Occlusion Myocardial Infarction with an AI-Powered ECG Model: A Retrospective Cohort Study.Journal of personalized medicine · 2026Article
- Review
- Pitfalls of Posterior Leads for Posterior Occlusion MI.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026Article
- Comparison of regional wall motion abnormalities in patients with occlusion myocardial infarction with and without ST-elevation myocardial infarction (STEMI).Clinical and experimental emergency medicine · 2025Article
- Reply: Circumflex Artery, Missed Occlusions, and Paradigm Shift.JACC. Advances · 2025Article
- Posterior Occlusive Myocardial Infarction on Chronic Right Bundle Branch Block.Journal of Brown hospital medicine · 2025Article
- International evaluation of an artificial intelligence-powered electrocardiogram model detecting acute coronary occlusion myocardial infarction.European heart journal. Digital health · 2024Article
- Beyond STEMI-NSTEMI Paradigm: Dante Pazzanese's Proposal for Occlusion Myocardial Infarction Diagnosis.Arquivos brasileiros de cardiologia · 2024Review
- Machine learning for ECG diagnosis and risk stratification of occlusion myocardial infarction.Nature medicine · 2023Observational
- Machine Learning for the ECG Diagnosis and Risk Stratification of Occlusion Myocardial Infarction at First Medical Contact.Research square · 2023Article
- From Q/Non-Q Myocardial Infarction to STEMI/NSTEMI: Why It's Time to Consider Another Simplified Dichotomy; a Narrative Literature Review.Archives of academic emergency medicine · 2022Review
- The effect of extent and localization of precordial ST-segment depression in acute inferior myocardial infarction as an indicator of infarct severity, coronary artery involvement, and cardiac outcomes.Therapeutic advances in cardiovascular diseaseArticle
- The inverse problem of electrocardiography: From a clinical point of view.JRSM cardiovascular diseaseReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors at 7 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background Occlusion myocardial infarctions (OMIs) of the posterolateral walls are commonly missed by ST-segment-elevation myocardial infarction (STEMI) criteria, with >50% of patients with circumflex occlusion not receiving emergent reperfusion and experiencing increased mortality. ST-segment depression maximal in leads V1-V4 (STDmaxV1-4) has been suggested as an indicator of posterior OMI. Methods and Results We retrospectively reviewed a high-risk population with acute coronary syndrome. OMI was defined from prior studies as a culprit lesion with TIMI (Thrombolysis in Myocardial Infarction) 0 to 2 flow or TIMI 3 flow plus peak troponin T >1.0 ng/mL or troponin I >10 ng/mL. STEMI was defined by the Fourth Universal Definition of Myocardial Infarction. ECGs were interpreted blinded to outcomes. Among 808 patients, there were 265 OMIs, 108 (41%) meeting STEMI criteria. A total of 118 (15%) patients had "suspected ischemic" STDmaxV1-4, of whom 106 (90%) had an acute culprit lesion, 99 (84%) had OMI, and 95 (81%) underwent percutaneous coronary intervention. Suspected ischemic STDmaxV1-4 had 97% specificity and 37% sensitivity for OMI. Of the 99 OMIs detected by STDmaxV1-4, 34% had <1 mm ST-segment depression, and only 47 (47%) had accompanying STEMI criteria, of which 17 (36%) were identified a median 1.00 hour earlier by STDmaxV1-4 than STEMI criteria. Despite similar infarct size, TIMI flow, and coronary interventions, patients with STEMI(-) OMI and STDmaxV1-4 were less likely than STEMI(+) patients to undergo catheterization within 90 minutes (46% versus 68%;
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