A New ECG Sign of Proximal LAD Occlusion

To the Editor: Recognition of characteristic changes in an electrocardiogram (ECG) that are associated with acute occlusion of a coronary artery guides decisions regarding immediate reperfusion therapy.1–3 Working from our primary database of percutaneous coronary interventions, which includes records of the ambulance, or admission, ECG (performed on first medical contact with the patient), the preprocedural ECG, and the coronary angiogram, we describe a new ECG pattern without ST-segment elevation that signifies occlusion of the proximal left anterior descending coronary artery (LAD). Instead of the signature ST-segment elevation, the ST segment showed a 1- to 3-mm upsloping ST-segment depression at . . .