⚠️ Note:
- 30-60% of anterior OMIs do NOT have reciprocal STD in inferior leads (Sources: PMID 8213517, PMID 10440150, PMID 8682009, PMID 11195604)
- The 🔢 4 Variable Formula can help distinguish subtle LAD occlusion from early repolarization
- It is critical to use it only when the differential is subtle LAD occlusion vs. early repol
- There must be ST Elevation of at least 1 mm in any of leads V2-V4.
- If there is LVH, it may not apply. If there are features that make LAD occlusion obvious (inferior or anterior ST depression, convexity, terminal QRS distortion, Q-waves, or ST Elevation of 5 mm or more), then the formula MAY NOT apply. These kinds of cases were excluded from the study as they were recognized as obvious anterior STEMI.
🚨 Suggestive of OMI:
- 4 variable formula value >18.2
- Terminal QRS distortion
✅ Suggestive of “Benign” Early Repolarization:
- Early repolarization always has prominent R-waves in V2-V4 (Source)