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Background <p>Electrocardiographic localization of the infarct-related artery in ST-segment elevation myocardial infarction is generally reliable; however, coronary anatomical variants and dynamic ischemic processes may result in misleading initial ECG patterns.</p> Case presentation <p>We describe a clinical scenario in which isolated inferior ST-segment elevation was the initial ECG manifestation of acute myocardial infarction, while coronary angiography revealed complete occlusion of the proximal left anterior descending artery. Subsequent angiography demonstrated a wrapped left anterior descending artery extending beyond the apex and supplying the inferior wall. Serial electrocardiograms showed a sequential evolution, with resolution of inferior ST-segment elevation after reperfusion followed by the emergence of anterior changes, rather than simultaneous multiterritory involvement.</p> Conclusion <p>Awareness of this dynamic ECG phenomenon is essential to avoid diagnostic delay in high-risk presentations.</p>

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Inferior ST-segment elevation as a diagnostic pitfall in proximal LAD occlusion: insights from a wrapped left anterior descending artery——a case report

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月27日

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  • Yu-Sha Zhang,
  • Jin-Qian Cao,
  • Ya-Xin Liao,
  • Qing-Yun Zheng,
  • Zhi-Hua Bian,
  • Jia He,
  • Li Shen,
  • Qing-Yi Zhu,
  • Ming-Qi Ouyang,
  • Jian-Jun Tang,
  • Ya-Qin Chen

摘要

Background

Electrocardiographic localization of the infarct-related artery in ST-segment elevation myocardial infarction is generally reliable; however, coronary anatomical variants and dynamic ischemic processes may result in misleading initial ECG patterns.

Case presentation

We describe a clinical scenario in which isolated inferior ST-segment elevation was the initial ECG manifestation of acute myocardial infarction, while coronary angiography revealed complete occlusion of the proximal left anterior descending artery. Subsequent angiography demonstrated a wrapped left anterior descending artery extending beyond the apex and supplying the inferior wall. Serial electrocardiograms showed a sequential evolution, with resolution of inferior ST-segment elevation after reperfusion followed by the emergence of anterior changes, rather than simultaneous multiterritory involvement.

Conclusion

Awareness of this dynamic ECG phenomenon is essential to avoid diagnostic delay in high-risk presentations.