Electrocardiographic patterns predict the presence of collateral circulation and in-hospital mortality in acute total
Chunwei Liu1,2, Fan Yang3, Jingxia Zhang2
1Tianjin Medical Universityy, Tianjin, China.
Insights
Electrocardiogram findings like ST-segment elevation in lead I and STEMI predict mortality in acute myocardial infarction from unprotected left main occlusion. Absence of collateral circulation is linked to shock in these critical cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Medicine
Background:
- Limited data exists on clinical characteristics, ECG findings, and outcomes for acute myocardial infarction (AMI) caused by total unprotected left main (ULM) artery occlusion.
- Understanding these factors is crucial for improving patient management and outcomes.
Purpose of the Study:
- To evaluate the clinical characteristics, electrocardiogram (ECG) findings, collateral circulation, and in-hospital mortality in patients with AMI due to total ULM occlusion.
- To identify predictors of shock and in-hospital mortality in this patient cohort.
Main Methods:
- Retrospective analysis of 44 patients with AMI due to total ULM occlusion who underwent primary percutaneous coronary intervention (PCI) between 2009 and 2021.
- Evaluation of ECG findings, collateral circulation, clinical presentation, procedural details, and in-hospital mortality.
Main Results:
- Twenty-five patients presented with shock, and 18 experienced in-hospital mortality.
- ST-segment elevation (STE) in lead I and STEMI were associated with absent collateral circulation.
- STE in aVR predicted collateral circulation presence, with specific patterns indicating collateral filling in different territories (LAD, LCx) in NSTEMI patients.
Conclusions:
- ECG findings, including STE in precordial leads and specific ST-segment changes in aVR/aVL, can predict collateral circulation status in ULM occlusion.
- STE in lead I, non-STE in aVR, and STEMI are significant predictors of in-hospital mortality in patients with AMI due to total ULM occlusion.
Background:
Data on the clinical characteristics, electrocardiogram (ECG) findings and outcomes of patients with acute myocardial infarction (AMI) due to total unprotected left main (ULM) artery occlusion is limited.
Methods:
Between 2009 and 2021, 44 patients with AMI due to total ULM occlusion underwent primary percutaneous coronary intervention (PCI) at our institution. The ECG, collateral circulation, clinical and procedural characteristics, and in-hospital mortality were retrospectively evaluated.
Results:
Twenty five patients presented with shock and 18 patients had in-hospital mortality. Nineteen patients presented with ST-segment elevation myocardial infarction (STEMI), while 25 presented with non-ST-segment elevation myocardial infarction (NSTEMI). ST-segment elevation (STE) in I and STEMI were associated with the absence of collateral circulation, while STE in aVR was associated with its presence. In the NSTEMI group, patients with STE in both aVR and aVL showed more collateral filling of the left anterior descending coronary artery (LAD) territory, while patients with STE in aVR showed more collateral filling of the LAD and the left circumflex artery territory. Compared with total ULM occlusion, patients with partial ULM obstruction presented with more STE in aVR, less STE in aVR and aVL, and less STEMI. Shock, post-PCI TIMI 0-2 flow, non-STE in aVR, STEMI, and STE in I predicted in-hospital mortality. STEMI and the absence of collateral flow were significantly associated with shock.
Conclusions:
STE in the precordial leads predicted the absence of collateral circulation while STE in aVR and STE in both aVR and aVL predicted different collateral filling territories in ULM occlusion. STE in I, non-STE in aVR, and STEMI predicted in-hospital mortality in these patients.
Related Concept Videos
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
01:30Acute Coronary Syndrome I: Introduction
01:28Electrocardiogram Fundamentals
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin...
01:28Acute Coronary Syndrome IV: Interprofessional Care