Electrocardiographic findings in true acute left main coronary total occlusion a subanalisys from ATOLMA registry
A Gutiérrez-Barrios1, D Mialdea-Salmerón2, D Cañadas-Pruaño1
1Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Spain.
Insights
Electrocardiogram (ECG) findings like ST-segment elevation in aVL and absence of ST-segment elevation in V1 can predict acute total occlusion of the left main coronary artery (ATOLMA). Fragmented QRS on ECG predicts in-hospital mortality in ATOLMA patients.
Area of Science:
- Cardiology
- Medical Diagnostics
- Electrocardiography
Background:
- Acute total occlusion of the left main coronary artery (ATOLMA) is a critical condition with high mortality.
- Early detection and reperfusion are crucial for improving patient outcomes.
- Electrocardiogram (ECG) may offer predictive value for ATOLMA.
Purpose of the Study:
- To identify specific 12-lead ECG features predictive of ATOLMA at admission.
- To determine ECG predictors for in-hospital mortality in patients with ATOLMA.
Main Methods:
- Retrospective analysis of ECG findings in 24 ATOLMA patients.
- Comparison of ATOLMA patient ECGs with those of 15 patients with acute subtotal left main occlusion (ASOLMA) and 15 with proximal LAD STEMI.
- Multivariate analysis to identify independent predictors.
Main Results:
- Predictive ECG features for ATOLMA include: left axis deviation, ST-segment elevation in aVL, absence of ST-segment elevation in V1, bifascicular block, fragmented QRS, and prolonged QRS and QTc intervals.
- Independent predictors differentiating ATOLMA from ASOLMA were aVL ST-segment deviation and absence of V1 ST-segment elevation.
- QRS width was an independent predictor differentiating ATOLMA from LADp-STEMI.
- Fragmented QRS was the sole independent predictor of in-hospital mortality in ATOLMA.
Conclusions:
- Specific ECG criteria, including aVL ST-segment elevation and absence of V1 ST-segment elevation, can predict ATOLMA.
- Fragmented QRS on admission ECG is a significant predictor of in-hospital mortality in patients with ATOLMA.
Introduction:
Acute total occlusion of the left main coronary artery (ATOLMA) usually leads to a catastrophic presentation. Prediction of ATOLMA by electrocardiogram (ECG) may contribute to early detection and reperfusion. Limited data have been reported previously. This study aims to identify the admission 12‑leads ECG features that can predict the presence of ATOLMA and in-Hospital mortality in these patients.
Methods:
The admission ECGs findings in 24 patients from the previously reported ATOLMA multicenter registry were compared to the ECGs findings in 15 patients with an acute subtotal occlusion of the left main (ASOLMA) and to 15 patients with anterior ST-elevation myocardial infarction of the proximal left anterior descending (LADp-STEMI).
Results:
Some ECG features at presentation can predict an ATOLMA: QRS left axis deviation (-61.17 ± 9 degrees); ST-segment elevation in aVL (1.9 ± 0.65 mm); absence of ST-segment elevation in V1 (0.0 ± 0.6 mm); bifascicular block (58%); fragmented QRS (62.5%); prolongation of QTc interval (465 ± 19 ms) and of QRS interval (136 ± 12 mm). The multivariate analysis found that the independent predictors to distinguish ATOLMA from ASOLMA were aVL ST-segment deviation (OR 5.6(95% CI 1.5-21), p = 0.01) and absence of V1 ST-segment elevation (OR 27(95% CI 1.4-52), p = 0.01); and from LADp-STEMI was QRS width (OR 1.1(95% CI 1.02-1.2), p = 0.02). Fragmented QRS was the only independent predictor of in-hospital mortality in ATOLMA (OR 0.125(95% CI 0.01-0.81), p = 0.03).
Conclusions:
aVL ST-segment elevation, the absence of V1 ST-segment elevation, left axis deviation, the presence of bifascicular block, and prolongation of QRS and QTc interval are predictors of ATOLMA. Fragmented QRS predicts in-hospital mortality in ATOLMA.
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