Electrocardiogram Predictors of Left Main Disease in Patients with Acute NSTEMI
AbstractBackground. The importance to identify Left Main (LM) disease in Coro-nary Artery Disease (CAD) patients is to define therapy strategy, progno-sis which can influence to length of hospitalization, survival rate, and the payment. Electrocardiogram (ECG) is a simple tool to diagnose patient with CAD.
Objectives. To identify ECG indicators as related to LM disease predic-tors.
Methods. 265 acute non ST elevation patients enrolled after having coro-nary angiography in National Cardiovascular Center Harapan Kita Jakarta. ST elevation, ST depression, T invertion of the 12 lead ECG and ST eleva-tion in aVR taller than V1 lead is further variable investigation. Chi-square and Mann-Withney test were done for statistical analysis. Logistic regres-sion was used in variable predictor test. Discrimination test was done by using Hosmer Lemeshow goodness of fit to determine validation model and area under curve test.
Results. The largest populations were male (210 patients – 82.3%). The age range from 37 until 80 years old (mean 59,9 ± 9,1 years), 77 patients were more than 65 years old. There were 90 patients with LM disease. There was ST elevation in aVR in 88 patients, and 87 patients had higher ST elevation compared to ST segment in V1. The significant factors are
elevation of ST segment in aVR, ST segment elevation in aVR > V1, ST depression in I, II, III, aVL, aVF, V2 - V6, ST elevation in lead aVR–V1, mul-tiple ST changes (elevation and depression) in many leads. Multivariate analysis showed the highest parameter to diagnose LM disease are ST el-evation in aVR and ST elevation aVR-V1 (mm) with area under curve 96% (sensitivity 92,22 / specificity 97,14 / PPV 94,31 / NPV 96,00 for ST eleva-tion in aVR and sensitivity 93,33 / specificity 98,29 / PPV 96,55 / NPV 96,62 for ST elevation aVR>V1).
Conclusions. ECG indicators for LM disease are ST elevation in aVR and ST elevation in aVR>V1.
Loop FD, Lytle BW, Sheldon WC, Irarrazaval M, Taylor PC, Groves LK, et al. Atherosclerosis of the Left Main Coronary Artery : 5 year results of surgical treatment. Am J Cardiol 1979;44:195-201.
Lim JS, Proundfit WL, Sones FM. Left main coronary arterial obstruction : long term follow up of 141 nonsurgical cases. Am J Cardiol 1975;36:131-35.
Bulkey BH, Robert WC. Atherosclerosis narrowing of the left main coronary artery. A necropsy analysis of 152 patients with fatal coronary heart disease and varying degrees of left main narrowing. Circulation 1976;53:823-28.
DeMots H, Bonchek LI, Rosch J, Anderson RP, Starr A, Rahimtoola SH. Left main coronary artery disease. Risks of angiography, importance of coexisting disease of other coronary arteries and effects of revascularization. Am J Cardiol 1975; 36:136-141.
Cohen M, Gorlin R. Left main coronary artery disease. Circulation 1975;52:275
Talano J, Scanlon P, Meadows W, Kahn M, Pifarre R, Gunar R. Influence of surgery on survival in 145 patients with left main coronary artery disease. Circulation 1975; 51 (suppl I);1-105.
Takaro T, Hultgren H, Lipton M, Detre K. The VA cooperative randomized study of surgery for coronary arterial occlusive disease, subgroup with significant left main lesions. Circulation 1976;54:107.
Lee MS, Kapoor N, Jamal F, Czer L, Aragon J, Forrester J et al. Comparison of Coronary Artery Bypass Surgery with Percutaneous Coronary intervention with Drug-Eluting Stents for Unprotected Left Main Coronary Artery Disease. J Am Coll
Ching CK, Hsu LF, Teo WS. Electrocardiographic Case: Diagnosis of Left Mainstem Disease in Unstable Angina. Asean Heart Journal 2001;8:47-9
Atie J, Brugada P, Smeets JLRM, Cruz FE, Roukens MP, Gorgels AP et al. Clinical presentation and prognosis of left main coronary artery disease. Eur Heart J 1991; 12:495-502.
Yamaji H, Iwasaki K, Kusachi S, Murakami T, Hirami R, Hamamoto H et al. Prediction of Acute Left Main Coronary Artery Obstruction by 12-Lead Electrocardiography. Am J Coll Cardiol 2001;38:1348-54.
Gaitonde RS, Sharma N, Hasan SA, Miller JM, Jayachandran V, Kalaria VG. Prediction of significant left main coronary artery stenosis by the 12-lead electrocardiography in patients with rest angina pectoris and withholding of clopidogrel therapy. Am J Cardiol 2003;92:846-8.
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