Key result
Rare apex-wrapping LAD occlusion manifests as inferior STEMI in left dominant circulation.
Why the study?
The rare occurrence of left coronary circulation dominance with a wrapped LAD causing inferior STEMI is not well recognized.
Case Report (n=3)
No
A wrapped LAD continuing as a posterior descending artery can present as an inferior STEMI when occluded, highlighting an important anatomical variant.
Wrap-around LAD may mimic inferior STEMI; Level 5 cases leave open whether ECG algorithms require anatomic adjustment.
We report three cases of acute myocardial infarction caused by left anterior descending (LAD) artery occlusion presenting as ST elevation in the inferior. Therefore, coronary angiography showed an occlusion of the LAD coronary artery. Our cases show the rare occurrence of left coronary circulation dominance affecting inferior leads. These cases show an unusual and very rare form of left dominance coronary circulation where LAD is wrapped around the apex and continuing as a posterior descending artery. This would make inferior myocardial infarction because of occluded LAD or determine as wrapped LAD.
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Novia Kusumawardhani (2021) conducted a case report in Acute myocardial infarction (STEMI) (n=3). Primary percutaneous coronary intervention (PCI) was evaluated. Three cases demonstrated a rare form of left dominance coronary circulation where the left anterior descending artery wraps around the apex, causing inferior ST-elevation myocardial infarction upon occlusion.
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