Finding LCX AMI With Posterior ECG LeadS

Clinical Impact of Pre-hospital Posterior ECG Leads Implementation for Identifying Occlusion of Left Circumflex Coronary Artery in ST Segment Elevation Myocardial Infarction

Status

UNKNOWN

Phases

Unknown

Study type

Observational

Source

ClinicalTrials.gov

Registry ID

NCT02788799

Acronym

FLAWLESs

Enrollment

1200

Registered

2016-06-02

Start date

2017-02-01

Completion date

2019-12-31

Last updated

2019-03-28

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Myocardial Infarction

Keywords

ST Elevation, LCX Artery

Brief summary

Along with symptoms of chest pain, the presence of ST segment elevations on ECG is the criterion usually used in practice to identify patients with acute coronary artery occlusion and is essential for the direct and acute referral of patients for primary PCI. However, ECG does not always reflect changes in the posterior wall of the heart, often equivalent to the left circumflex coronary artery's (LCX) supply area, resulting in an underrepresentation of LCX as culprit artery in STEMI populations. There is a general concern that some patients with genuine acute occlusion of LCX may present without ST segment elevation and be denied reperfusion therapy, resulting in larger infarction and worse outcome. The aim of this trial is to implement record of posterior ECG leads (V7, V8 and V9) in addition to the standard 12-lead ECG in the pre-hospital setting and to evaluate the clinical impact of this implementation: In comparison to a control cohort of STEMI patients diagnosed with a pre-hospital standard 12-lead ECG prior study start, the investigators hypothesize that introducing V7-V9 leads as a clinical routine in the pre-hospital setting will identify patients with STEMI involving LCX and with a non-diagnostic standard 12-lead ECG.

Interventions

OTHERStandard 12-Lead ECG

Conventional record of Standard 12-lead ECG in every patient with suspect of acute coronary syndrome.

OTHERPosterior ECG Leads

Recording posterior ECG leads (V7, V8 and V9) in addition to standard 12-lead ECG for identifying STEMI involving left cirumflex coronary artery.

Study design

Observational model

CASE_CONTROL

Time perspective

OTHER

Eligibility

Sex/Gender

ALL

Healthy volunteers

Inclusion criteria

Intervention group: * All STEMI patients referred directly from the pre-hospital setting, treated with primary PCI and with available standard 12-lead ECG and ECG with V7-V9 leads.

Exclusion criteria

* STEMI patients treated with primary PCI and no ECG with V7-V9 leads.

Design outcomes

Primary

Measure	Time frame
Proportion of patients with LCX occlusion as culprit artery in the intervention group compared to the control group	Day one - culprit lesion treated with primary PCI

Secondary

Measure	Time frame
Proportion of patients in the intervention group with STEMI involving LCX artery, non-diagnostic standard 12-lead ECG and ST segment elevation >0,5 mm in ≥2 leads in posterior ECG leads (V7-V9).	Day one - culprit lesion treated with primary PCI

Countries

Denmark

Contacts

Primary ContactYama Fakhri, MD

yama.said.fakhri@regionh.dk+4535451196

Backup ContactJens Kastrup, MD, Professor

+4535452819

Outcome results

None listed

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026