Aslanger et coll. ont identifié en 2020 un aspect ECG spécifique (Aslanger pattern) qui prédit un infarctus aigu dans le territoire inférieur par occlusion de l’artère coronaire droite ou de la circonflexe malgré un sus-décalage de ST minime en DIII et uniquement en DIII [1].
Le pattern d’Aslanger a été observé chez 6,3 % (61/966) des 1000 patients de la cohorte des infarctus non ST+ avec coronarographie de référence et 0,5 % (5/1000) des patients sans infarctus du myocarde. Les patients avec le pattern avaient une maladie multivasculaire, un infarctus de taille plus grande et un pronostic moins bon que les patients qui avaient un infarctus inférieur avec un sus-décalage de ST académique (ST+ ≥ 1 mm dans deux des trois dérivations DII-DIII-VF).
Ce pattern est considéré comme un équivalent ST+, c’est à dire un infarctus par occlusion coronaire aiguë sans ST+ académique.
Le pattern d’Aslanger
Il comprend trois signes
1) Inferior STE isolated to lead III
2) Concomitant ST depression in any of V4-V6, with a positive/terminally positive T-wave
3) ST segment in V1 > V2
Le ST- est relativement diffus, affecte V4-V6, VR et V1 et DI-DII-VL ce qui s’oppose au ST+ en VF car VF = 1/2 (DII + DIII) [2].
Références
[1] Aslanger E, Yıldırımtürk Ö, Şimşek B, Sungur A, Türer Cabbar A, Bozbeyoğlu E, Karabay CY, Smith SW, Değertekin M. A new electrocardiographic pattern indicating inferior myocardial infarction. J Electrocardiol. 2020 Jul-Aug;61:41-46.
Methods: One thousand patients with a diagnosis of non-STEMI were enrolled as the study group. Within the same date range, all patients with inferior STEMI and 1000 patients, who had been excluded for MI (no-MI), were also enrolled. The coronary angiograms were reviewed by two interventional cardiologists, who were blinded to the ECGs. Echocardiographic wall motion bullseye displays and coronary angiography maps were constructed for each group. The dead or alive status was checked from the electronic national database.
Results: The final study population consisted 2362 patients. The prespecified ECG pattern was observed in 6.3% (61/966) of the non-STEMI cohort and 0.5% (5/1000) of no-MI patients. These patients had a larger infarct size as evidenced by 24-hour troponin levels, higher frequency of angiographic culprit lesion, and higher frequency of composite acute coronary occlusion endpoint compared to their non-STEMI counterparts. On the other hand, they had a similar in-hospital (5% vs. 4%, respectively; P = 0.675) and one-year mortality compared to the patients with inferior STEMI (11% vs. 8%, respectively; P = 0.311).
Conclusion: We here define a new ECG pattern indicating inferior MI in patients with concomitant critical lesion(s) in coronary arteries other than the infarct-related artery. Patients with this pattern have multivessel disease and higher mortality.
[2] Aslanger Pattern: Another OMI? Source : Life in the Fast Lane • LITFL