Prediction of left main coronary artery obstruction by 12-lead electrocardiography: ST segment deviation in lead V6...

Area of Science:

• Cardiology
• Electrocardiography
• Emergency Medicine

Background:

• Acute coronary syndrome (ACS) from left main coronary artery (LMCA) lesions can cause rapid hemodynamic instability.
• Early identification of LMCA disease is crucial for timely revascularization.
• ST segment elevation in lead aVR (aVR-V(1)≥0) has been proposed as a predictor of LMCA disease.

Purpose of the Study:

• To evaluate the diagnostic accuracy of ST deviation in lead V(6) versus V(1) (V(6)-V(1)≥0) for predicting LMCA disease in ACS patients.
• To compare the sensitivity of V(6)-V(1)≥0 and V(6)/V(1)≥1 with aVR-V(1)≥0 and aVR/V(1)≥1 in diagnosing LMCA culprit lesions.

Main Methods:

• Retrospective analysis of 12-lead ECGs from 75 ACS patients with LMCA culprit lesions (Group I) and 81 with left anterior descending culprit lesions (Group II).
• Comparison of ST deviation criteria: V(6)-V(1)≥0, V(6)/V(1)≥1, aVR-V(1)≥0, and aVR/V(1)≥1.
• Analysis focused on patients with non-isoelectric ST segments in lead V(1).

Main Results:

• ST deviation in V(6) was significantly greater in the LMCA group (Group I) compared to the LAD group (Group II) (P < 0.001).
• The reliability of V(6)-V(1)≥0 and V(6)/V(1)≥1 in predicting LMCA disease was determined.
• These criteria demonstrated significant predictive value for LMCA culprit lesions.

Conclusions:

• ST deviation in V(6)≥V(1) and the ratio V(6)/V(1)≥1 are more sensitive predictors of LMCA culprit lesions in ACS.
• These ECG findings offer a valuable tool for early identification of LMCA disease, potentially improving patient outcomes.
• This study represents the largest series of ECG analysis specifically on ACS resulting from culprit LMCA lesions.