[The threat syndrome of the anterior descending coronary artery]

Some patients with unstable angina develop a deep T-wave inversion in ECG leads V1 to V4. It has been suggested that this special ECG pattern is associated with a severe stenosis of the left anterior descending (LAD) coronary artery. We have studied 73 of this patients. All of them had an LAD involvement, nearly always as severe atherosclerotic plaque and in 5% of the cases due to non-atherosclerotic alterations (milking or spasm). Angioplasty was performed in 33% and bypass surgery in 61%. In both cases the immediate results were good (0% and 4% respectively in-hospital mortality) as well as the outcome (12% restenosis and 0% late mortality respectively). The ECG signs disappeared in the year after.