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Clinical and electrocardiographic features in acute total left main coronary artery occlusion without collateral

Hang Zhou1, Yen Shu Huang2, Yun-Tao Zhao3

  • 1Senior Department of Cardiology, The Sixth Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, People's Republic of China.

Journal of Electrocardiology
|December 13, 2022
PubMed

Insights

Acute total left main coronary artery occlusion without collateral circulation leads to high mortality. Specific ECG patterns, including anterior ST elevation and inferior ST depression, may indicate this critical condition.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • Limited data exists on clinical features, ECG findings, and outcomes for acute total left main coronary artery (LM) occlusion without collateral circulation.
  • Understanding this specific clinical scenario is crucial for timely diagnosis and management.

Purpose of the Study:

  • To investigate the clinical characteristics, electrocardiogram (ECG) findings, and in-hospital outcomes of patients with acute total LM occlusion and no collateral circulation.
  • To identify potential ECG predictors associated with this condition.

Main Methods:

  • Retrospective analysis of 25 patients with acute total LM occlusion without collateral circulation from a multi-center registry.
  • Review of clinical, angiographic, and ECG data, as well as in-hospital mortality.

Main Results:

  • High incidence of cardiogenic shock (76%) and no-reflow phenomenon post-PCI (60%).
  • Substantial in-hospital mortality rate of 88%.
  • Consistent STEMI pattern with anterior ST elevation (leads I, aVL, V2-V5) and inferior ST depression (leads II, III, aVF) observed in all patients.

Conclusions:

  • Acute total LM occlusion without collateral circulation is associated with extremely high in-hospital mortality.
  • Specific ECG findings (anterior ST elevation in precordial and limb leads, inferior ST depression) are strongly linked to acute total LM occlusion without collateral circulation.
Abstract

Keywords:
Acute total left main occlusionElectrocardiogramIn-hospital mortality

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