P-310 Clinical Significance of ST Segment Elevation in Lead aVR as Predictor of Left Main Coronary Artery Occlusion in Acute Coronary Syndrome

2009 ◽  
Vol 4 ◽  
pp. S139
Author(s):  
Norberto Ocapan Tuano ◽  
Ronaldo Cristobal Manuel
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Left Main ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Lead Avr

scholarly journals Prediction of Left Main Coronary Artery Occlusion by ST Segment Elevation in Lead aVR Greater than that in Lead V1 in Acute Coronary Syndrome

2017 ◽  
Vol 9 (2) ◽  
pp. 77-82
Author(s):  
Abdul Azeez Ahemd ◽  
Mahboob Ali ◽  
Abdullah Al Shafi Majumder ◽  
M Atahar Ali ◽  
Md Shafiqur Rahman Patwary ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Left Ventricular ◽  
Left Main ◽  
Predictive Values ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Group I ◽  
St Segment ◽  
Lead Avr

Background: The electrocardiogram (ECG) predicting an acute obstruction of the LMCA, which requires immediate aggressive treatment, is very important for early diagnosis. We correlated ST segment elevation in lead aVR greater than that in lead V• with coronary angiographic diagnosis of LMCA occlusion in patients with acute coronary syndrome.Methods: Cross sectional analytical study was conducted in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from August 2011 to July 2012. Total 90 patients were included purposively. Study population was divided into two groups. Group I- Patients with ST segment elevation in aVR greater than ST segment elevation in V• (n=45) and group II- Patients with ST segment elevation in aVR less than that in lead V• (n=45). In hospital outcomes were observed for cardiogenic shock, left ventricular failure, hypotension, arrhythmia and death.Results: Acute LVF was significantly (P<0.05) higher in group I but other complications were not significant (P>0.05) between two groups. LM involvement was significantly higher in group I (91.1% vs. 20.0%, p<0.05). ST segment elevation in aVR greater than ST segment elevation in V• (n=45) for prediction of LM significant disease has got a sensitivity of 82.0%, specificity 90.0%, accuracy 85.6%, positive and negative predictive values were 91.1% and 80.0% respectively.Conclusion: ST segment deviation in lead aVR greater than that in lead V1 is supposed to be a positive predictor of left main coronary artery obstruction with highly sensitivity and accuracy. Precordial leads V1 and V6 can also predict the critical LMCA obstruction in patients with acute coronary syndrome.Cardiovasc. j. 2017; 9(2): 77-82

scholarly journals Significance of ST Segment Elevation in Lead aVR in Patients with Non-ST Elevation Acute Coronary Syndrome

2019 ◽  
Vol 14 (2) ◽  
pp. 71-76
Author(s):  
Pritam Kumar Gachchhadar ◽  
Manzoor Mahmood ◽  
Dipal Krishna Adhikary ◽  
MSI Tipu Chowdhury ◽  
Md Ashraf Uddin Sultan ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Area Under The Curve ◽  
Left Main ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Triple Vessel Disease ◽  
St Segment ◽  
Lead Avr ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

Background: As acute occlusion of the left main (LM) artery causes life-threatening hemodynamic deterioration and malignant arrhythmias, resulting in an adverse outcome, a rapid diagnosis and subsequent urgent revascularization with percutaneous coronary intervention (PCI) or coronary bypass surgery is very important in this subset of patients. The 12-lead electrocardiogram (ECG) is a crucial tool in the diagnosis and risk stratification of acute coronary syndrome (ACS). Unlike other 11 leads, lead aVR has been long neglected until recent years. Objective: To determine the accuracy of 12-lead electrocardiography in predicting left main and/or triplevessel disease in patients with non-ST elevation acute coronary syndrome (NSTE- ACS). Methodology: This cross sectional observational study carried out among patients presenting with non-ST elevation acute coronary syndrome at Cardiac Emergency Department or CCU of BSMMU. This study was conducted from May 2017 to April 2018. A total of 36 patients meeting the eligibility criteria were consecutively included. Data collection was carried out by using a questionnaire. Informed written consent was obtained from the hospital authority. Analysis of data was finally done with Statistical Package for Social Science program 17 version of computer on the basis of different variables. Result: As ST-segment elevation in lead aVR is a continuous variable, a suitable cut-off for ST- elevation in lead aVR was found out for diagnosing LM and/or triple vessel disease (TVD) using ROC curve. The cut-off value was 0.75 mm which gave us an optimum sensitivity of 88.5% and a specificity of 80% with an area under the curve being 0.892(95% CI = 0.785-1.000), p < 0.001. The area under the curve demonstrated that 89.2% of the LM and/or TVD were correctly diagnosed with ST elevation e” 0.75 mm in lead aVR in patients with non-ST segment elevation acute coronary syndrome. The positive predictive value was commendably high (92%) and negative predictive value was no less (72.7%) with an overall diagnostic accuracy of 86%. Conclusion: From the findings of the study it can be concluded that ST- segment elevation e”0.75 mm in lead aVR in patients of non-ST segment elevation acute coronary syndrome had optimum sensitivity and specificity with an appreciably high overall diagnostic accuracy. The ST- segment elevation e”0.75 mm in lead aVR in patients with non-STE-ACS can differentiate LM and/or triple vessel disease with fair degree of accuracy. University Heart Journal Vol. 14, No. 2, Jul 2018; 71-76

scholarly journals Cardiac arrest due to critical stenosis of a bicuspid aortic valve mimicking left main coronary artery occlusion on ECG

2018 ◽  
pp. bcr-2018-225307
Author(s):  
Abhinav Saxena ◽  
Nitin Sabharwal ◽  
Bernard Topi ◽  
Gregory Crooke
Keyword(s):  
Cardiac Arrest ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Left Main Coronary Artery ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Left Main ◽  
St Depression ◽  
St Segment

A 49-year-old man presented to the emergency room after a cardiac arrest. On arrival, the patient’s ECG showed ST-segment elevations in the aVR and anteroseptal leads with diffuse ST depression suggestive of left main coronary artery occlusion. Subsequent coronary catheterisation showed normal coronaries but revealed severe stenosis of his bicuspid aortic valve. A surgical replacement of the aortic valve was performed, and the patient recovered successfully.

Electrocardiographic characteristics associated with in-hospital outcome in patients with left main acute coronary syndrome: For contriving a new risk stratification score

2016 ◽  
Vol 7 (3) ◽  
pp. 200-207 ◽  
Author(s):  
Takayuki Iida ◽  
Fumito Tanimura ◽  
Kyoko Takahashi ◽  
Hideki Nakamura ◽  
Satoshi Nakajima ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Qrs Complex ◽  
Left Main ◽  
Survival Group ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Lead Avr ◽  
Risk Stratification Score

Aim: The aim of this study was to evaluate electrocardiographic characteristics associated with in-hospital prognosis in patients with left main acute coronary syndrome. Methods and results: A total of 89 left main acute coronary syndrome subjects were selected from 3357 consecutive acute coronary syndrome patients (2.7%). Patients of this study were divided into two groups; those who survived and those who died. Patients’ characteristics and electrocardiogram on admission were then retrospectively analyzed between the two groups. In-hospital mortality was 28.1%. The prevalence and degree of ST-segment elevation at lead aVL were significantly higher in the deceased group than in the survival group ( p<0.001). However, those at lead aVR did not show significant differences between the two groups. Moreover, the width of the QRS-complex was significantly wider (lead V3; p<0.001), and the level of five minus the absolute value of five minus number of ST-segment elevation (5–|5–ST|; due to the highest in-hospital mortality (70%) in the five-lead ST-segment elevation group) was significantly larger in the deceased group than in the survival group ( p<0.001). The odds ratios that predicted in-hospital cardiac death were 1.03 for width of the QRS-complex at lead V3 (95% confidence interval (CI); 1.01–1.06; p=0.003), 1.74 for 5–|5–ST| (95% CI; 1.03–3.00; p=0.040), and 1.44 for ST-segment elevation at lead aVL (95% CI; 0.93–2.23; p=0.100). Conclusions: ST-segment elevation at lead aVL rather than aVR, width of the QRS-complex at lead V3 and number of ST-segment elevation were the prognostic predictors for in-hospital mortality in patients with left main acute coronary syndrome. Electrocardiographic characteristics should be assessed in addition to the established risk score in patients with left main acute coronary syndrome.

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