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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

Diffuse ST depression with ST elevation in aVR: Is this pattern specific for global ischemia due to left main

Robert J Knotts1, James M Wilson, Edward Kim

  • 1The Section of Cardiology, The Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.

Journal of Electrocardiology
|January 15, 2013
PubMed

Insights

The specific electrocardiogram (ECG) pattern showing ST depression and ST elevation is not a reliable predictor of left main coronary artery stenosis. This ECG finding may indicate other cardiac conditions, not exclusively left main disease.

Area of Science:

  • Cardiology
  • Electrocardiography
  • Ischemic Heart Disease

Background:

  • A specific electrocardiogram (ECG) pattern involving ST depression and ST elevation is observed in patients with suspected cardiac ischemia.
  • This ECG pattern has been historically associated with significant coronary artery disease, particularly involving the left main coronary artery (LMCA).

Purpose of the Study:

  • To evaluate the predictive value of a specific ECG pattern (ST depression in >7 leads with ST elevation in aVR and V1) for LMCA stenosis or left main equivalent (LMEQ) disease.
  • To determine if this ECG pattern is a reliable diagnostic tool for identifying critical coronary artery blockages.

Main Methods:

  • A cohort of 133 patients presenting with the specified ECG pattern was retrospectively analyzed.
  • Patients with left bundle branch block or ventricular rhythms were excluded to isolate the study population.
  • Coronary angiography was performed in a subset of patients to assess for significant coronary artery disease.

Main Results:

  • Only 23% of patients with the characteristic ECG pattern were diagnosed with LMCA/LMEQ disease upon coronary angiography.
  • A significant proportion of patients (26%) had no significant coronary artery disease, despite the concerning ECG findings.
  • Excluding patients with conduction abnormalities or dynamic ECG changes did not improve the positive predictive value of the ECG pattern for LMCA/LMEQ disease.

Conclusions:

  • The studied ECG pattern is not exclusively indicative of LMCA/LMEQ disease.
  • The term "suspect circumferential subendocardial ischemia" may be a more appropriate descriptor for this ECG finding.
  • Clinicians should consider alternative diagnoses in patients presenting with this ECG pattern, as other medical conditions can manifest similarly.
Abstract

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