ArticleCureus2026
South African Flag Sign During Atrial Fibrillation: Physician Recognition of Acute Proximal Left Anterior Descending Artery Occlusion Despite No Automated ST-Segment Elevation Myocardial Infarction Alert.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The South African flag sign (SAFS) is a non-contiguous electrocardiographic pattern defined by ST-segment elevation (STE) in leads I, aVL, and V2 with reciprocal inferior ST-segment depression (STD), classically associated with first diagonal branch (D1) occlusion. We report a 58-year-old female presenting with acute chest pain and atrial fibrillation (AF), whose 12-lead electrocardiogram (ECG) demonstrated a SAFS phenotype. Automated ECG interpretation generated no ST-segment elevation myocardial infarction (STEMI)-specific alert, classifying the tracing as AF with possible subendocardial injury. This failure may have resulted from AF-induced RR variability combined with non-contiguous STE distribution outside standard algorithmic thresholds. Visual pattern recognition prompted STEMI pathway activation before hospital arrival. Coronary angiography confirmed acute thrombotic total occlusion of the proximal left anterior descending artery (LAD) with Thrombolysis in Myocardial Infarction
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