Jeopardised Inferior Myocardium (JIM) score: an arithmetic electrocardiographic score to predict the infarct-related artery in inferior myocardial infarction

<p><b>INTRODUCTION</b>A few electrocardiographic criteria have been described to identify the infarct-related artery in inferior myocardial infarction. The aim of this study was to devise an arithmetic score to further improve the diagnostic accuracy.</p><p><b>MATERIALS AND METHODS</b>From 2004 to 2006, 78 patients who underwent primary angioplasty for inferior myocardial infarction within 6 hours from symptom onset were recruited for electrocardiographic and angiographic analysis.</p><p><b>RESULTS</b>The mean age of patients was 65 ± 12 years with male predominance (74%). Less ST depression in lead I and aVL, and more prominent ST depression in lead V1-3 were observed in left circumflex artery (LCX) than right coronary artery (RCA) occlusions. In addition, more prominent ST depression in lead I and ST elevation in V1 were found in proximal RCA than distal RCA occlusions. Based on the findings, the Jeopardised Inferior Myocardium (JIM) score was constructed and defi ned as [II-V3/III+V1- I]. The sensitivity and specificity of JIM score ≤0.5 to predict proximal RCA occlusions; 0.5 <JIM score ≤1.5 to predict distal RCA occlusions; and JIM score >1.5 to predict LCX occlusions were 58% and 85%, 69% and 68%, and 79% and 94%, respectively. The accuracy of prediction is slightly better than the 2 previously reported criteria.</p><p><b>CONCLUSION</b>By taking into account more leads, the JIM score is capable of identifying the infarct-related artery with an improved diagnostic accuracy.</p>

Clinical and angiographic findings of complete atrioventricular block in acute inferior myocardial infarction

<p><b>INTRODUCTION</b>The angiographic findings and prognosis of patients with complete atrioventricular block (AVB) complicating acute inferior myocardial infarction (MI) remain unclear.</p><p><b>MATERIALS AND METHODS</b>The clinical and angiographic findings of 70 consecutive patients with complete AVB were compared with those of 319 patients with inferior MI without AVB (control group) admitted within the same study period.</p><p><b>RESULTS</b>Patients with complete AVB were older (68 +/- 12 vs 63 +/- 13 years; P = 0.004) and clustered with clinical features indicative of larger infarct size, such as right ventricular infarction, cardiogenic shock, or low left ventricular ejection fraction (LVEF). The onset of the complete AVB was observed within 24 hours in 62 (88.6%), preceded by second-degree AVB in 26 (37.1%) and the escape QRS complex was wide in 8 (11.4%) patients. In patients with complete AVB, a dominant right coronary artery occlusion was found in >95% of cases and in-hospital mortality was increased (27.1% vs 10.7%; P = 0.000), especially in those with widen QRS escape rhythm (75.0%). Reperfusion therapy had a positive impact on the natural course of complete AVB.</p><p><b>CONCLUSIONS</b>Complete AVB in acute inferior MI was associated with advanced age and larger infarct size. Complete AVB was virtually always caused by dominant right coronary artery occlusion. The in-hospital mortality was significantly higher, but improved by reperfusion therapy. No permanent pacemaker is performed at a mean follow-up of 47 months.</p>

Angioplasty on an infarct-related anomalous right coronary artery arising from posterior coronary sinus

<p><b>INTRODUCTION</b>The objective of this case report was to illustrate the diagnostic and intervention approach of anomalous right coronary artery (RCA).</p><p><b>CLINICAL PICTURE</b>A 60-year-old man presented with acute inferior myocardial infarction. Cardiac catheterisation revealed an anomalous RCA arising from the posterior coronary sinus as the infarct-related artery.</p><p><b>TREATMENT</b>Ad hoc percutaneous coronary intervention with stent implantation was performed using a few technical modifications.</p><p><b>OUTCOME</b>Good angiographic result was achieved within 90 minutes, with 260 mL of contrast used.</p><p><b>CONCLUSION</b>A high index of suspicion and logical diagnostic and intervention approach are required for the proper management of anomalous RCA.</p>