This pattern of isolated ST-segment elevation in lead III, ST-segment depression in V4 through V6, and ST-segment elevation in V1 greater than V2 was first introduced and published in 2020. It is a strong predictor of acute coronary occlusion in the inferior distribution (left circumflex >> right coronary artery) in patients with concomitant multi-vessel disease and is an indication for emergent reperfusion. The pattern is defined as (1) any STE in DIII but not in other inferior leads, (2) STD in any of leads V4 to V6 (but not in V2) with a positive or terminally positive T-wave, (3) ST in lead V1 higher than ST in V2.
Aslanger Pattern
Examples
ST-elevation Myocardial Infarction (Aslanger Pattern)
This pattern is eponymously known as the Aslanger pattern. This pattern of isolated ST-segment elevation in lead III, ST-segment depression in V4 through V6, and ST-segment elevation in V1 greater than V2 was first introduced and published in 2020 and is a strong predictor of a culprit plaque in the inferior distribution (left circumflex >> right coronary artery) in patients with concomitant multi-vessel disease. This patient had an occluded graft (from prior bypass) in the right coronary distribution.
Aslanger Pattern
This patient had known multivessel disease a left heart catheterization revealed an in-stent thrombosis of the right coronary artery.References
- Aslanger E, Yıldırımtürk Ö, Şimşek B, et al. A new electrocardiographic pattern indicating inferior myocardial infarction. J Electrocardiol. 2020;61:41-46. doi:10.1016/J.JELECTROCARD.2020.04.008
- Ricci F, Martini C, Scordo DM, Rossi D, Gallina S, Fedorowski A, Sciarra L, Chahal CAA, Meyers HP, Herman R, Smith SW. ECG Patterns of Occlusion Myocardial Infarction: A Narrative Review. Ann Emerg Med. 2025 Apr;85(4):330-340. doi: 10.1016/j.annemergmed.2024.11.019. Epub 2025 Jan 17. PMID: 39818676.