the association of right coronary artery conus branch size and course with st segment elevation of right precordial leads and clinical outcome of acute anterior myocardial infarction

Introduction: coronary artery disease is the leading cause of death worldwide and electrocardiogram (ecg) is a reliable diagnostic tool to determine a myocardial infarction. the present study tried to compare the relationship between the ecg findings and angiographic findings in patients with acute anterior myocardial infarction.methods: seventy-four patients with acute anterior st elevation myocardial infarction (ant- stemi) presenting to the emergency room in the first 12 hours after the onset of symptoms were studied. upon admission, a full 14-lead ecg (including leads v3r and v4r) were performed. angiographic and ecg findings, as well as clinical outcome were compared between two groups. the statistical tests including chi-square and independent t-test were used for data analysis.results: small conus branch was seen in 52 (70.3%) and large conus in 22 ( 29.7%) patients. ste in right-sided leads and heart failure were significantly higher in small conus branch group versus large conus branch (88.6% vs 11.4%, p < 0.001 and 34.6% vs 9.1%, p = 0.02 respectively). there was no significant difference in mortality rate between the two groups (5.8% in small conous group vs 0% in large conus group, p = 0.55). there was a significant difference in major adverse cardiac events (mace) between the two groups (51.9% in small conous group vs 18.2% in large conus group, p = 0.01).conclusion: in patients with anterior mi, small conus branch was associated with higher rate of major adverse cardiac events mostly because of increased rate of acute heart failure.