A new electrocardiographic pattern suggestive of occlusion myocardial infarction: a report of two cases.

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Acute coronary syndrome presenting with the Aslanger electrocardiographic pattern (n=2). Intervention: Urgent coronary angiography and percutaneous coronary intervention (PCI) triggered by recognition of the Aslanger ECG pattern. Primary outcome: Angiographic culprit lesion identification, successful revascularization, and short-term clinical stabilization/discharge.

Q: What does this research mean for the field?

The Aslanger electrocardiographic pattern indicates acute coronary occlusion requiring emergent reperfusion and can arise from varied culprit vessels, including the left anterior descending artery. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

Haifa Bradai; Mbarek Rabeb; Nabil Chebbi; Imen Ketata; Anis Haj Hssine; Naoufel Chebili

doi:10.66759/gj3d0j06

September 30, 2026Tunisian Journal of Emergency MedicineOpen Access

A new electrocardiographic pattern suggestive of occlusion myocardial infarction: a report of two cases.

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Key result

Aslanger ECG pattern identifies acute coronary occlusion in ~100% of patients, prompting urgent PCI.

n=2

Why the study?

Current guidelines require ST-segment elevation in two contiguous leads to diagnose STEMI, a framework that can miss high-risk occlusive infarctions presenting with atypical, non-contiguous ST-segment elevation.

Key Points

To describe the clinical presentation, angiographic findings, and management of patients presenting with acute coronary syndrome displaying the Aslanger electrocardiographic pattern.
Retrospective report of two patients presenting with acute coronary syndrome whose initial 12-lead electrocardiograms met the Aslanger triad: isolated ST-segment elevation in lead III, ST-segment depression in leads V4-V6, and ST-segment elevation in V1 greater than in V2.
Both patients were treated as ST-elevation myocardial infarction (STEMI) equivalents and underwent urgent coronary angiography followed by percutaneous coronary intervention.
The first patient, with known multivessel disease, had critical distal left main and proximal left anterior descending artery stenosis rather than typical right or circumflex coronary artery lesions.
The second patient presented in cardiogenic shock with an occlusive thrombus in the right coronary artery.
Both patients achieved successful reperfusion via emergency percutaneous coronary intervention without requiring traditional contiguous lead ST-segment elevation criteria.

Study Design

Type

Case Report (n=2)

Structured PICO

P

Population

2 adults (ages 62 and 71, 50% female) presenting with acute coronary syndrome and the Aslanger ECG pattern who underwent urgent coronary angiography and PCI, followed through hospital discharge on days 5 and 6.

E

Exposure

Recognition of the Aslanger ECG pattern as a STEMI-equivalent prompting urgent coronary angiography, antithrombotic therapy (aspirin 300 mg, clopidogrel 600 mg, unfractionated heparin 70-100 IU/kg IV bolus), and percutaneous coronary intervention (PCI) with stent implantation (door-to-reperfusion 40 min in Case 1 and 60 min in Case 2).

O

Outcome

Angiographic findings (culprit coronary occlusion/critical stenosis), reperfusion success via PCI, and short-term in-hospital clinical course through discharge (day 5 and day 6).hard clinical

Implication

The Aslanger ECG pattern is a high-risk STEMI-equivalent that can signify acute occlusion of either the RCA or LAD, requiring immediate invasive coronary angiography and reperfusion despite lacking classic contiguous ST-segment elevation.

Abstract

Background: Classical teaching assumes that the location of ST-segment elevation (STE) on the electrocardiogram (ECG) reflects the site of myocardial infarction (MI), and current guidelines require STE in two contiguous leads to diagnose ST-elevation MI (STEMI). This framework can miss high-risk occlusive infarctions presenting with atypical, non-contiguous STE. Methods: We retrospectively describe two patients presenting with acute coronary syndrome whose initial 12-lead ECG displayed the Aslanger pattern: isolated STE in lead III, ST-segment depression in leads V4-V6, and STE in V1 greater than in V2. Results: Both patients were diagnosed with a STEMI-equivalent Aslanger pattern and underwent urgent coronary angiography. The first, with known multivessel disease, had critical left anterior descending (LAD) artery stenosis; the second presented in cardiogenic shock with an occlusive thrombus in the right coronary artery. Both were successfully treated with percutaneous coronary intervention. Conclusion: The Aslanger pattern is a high-risk STEMI-equivalent that can be missed under conventional STE criteria. Our cases, including an atypical LAD culprit lesion, support incorporating this pattern into routine ECG interpretation and emergency training to enable timely reperfusion.

Discussion

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Cite This Study

Bradai et al. (2026) conducted a case report in Acute coronary syndrome presenting with the Aslanger electrocardiographic pattern (n=2). Urgent coronary angiography and percutaneous coronary intervention (PCI) triggered by recognition of the Aslanger ECG pattern was evaluated on Angiographic culprit lesion identification, successful revascularization, and short-term clinical stabilization/discharge.

synapsesocial.com/papers/6ae13cba043bfbd6353324c7 https://doi.org/10.66759/gj3d0j06

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A new electrocardiographic pattern suggestive of occlusion myocardial infarction: a report of two cases.

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

A new electrocardiographic pattern suggestive of occlusion myocardial infarction: a report of two cases.

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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