Factors Predicting Mortality in Patients after Myocardial Infarction Caused by Left Main Coronary Artery Occlusion. Significance of ST Segment Elevation in Both aVR and aVL Leads.

Abstract

SUMMARYAcute left main coronary artery obstruction is rare and most patients in this clinical setting die of sudden death or cardiogenic shock. During the past 8 years, we encountered 13 patients with acute myocardial infarction caused by total occlusion of the left main coronary artery (LMCA-AMI). Thus, we surveyed these patients, and attempted to elucidate helpful predictors related to the prognosis. Six of 13 patients with LMCA-AMI survived. Successful left coronary artery dilatation was achieved in all survivors (group S), and in 5 (71%) non-survivors (group non-S). The age was not different between the two groups. A past history of angina was confirmed in 83% of group S, while only in 29% of group non-S. Clinical findings such as time of onset of AMI, interval from the AMI onset to admission, elapsed period from the AMI onset to recanalization of LMCA and the value of CK on admission were not different between the two groups. However, cardiogenic shock occurred in only 1 patient (17%) in group S compared with 5 patients (71%) in group non-S. As emphasized in the literature, good collateral circulation to the left anterior descending artery was observed in 5 patients (83%) in group S, while not observed in group non-S. Electro cardiographically, ST elevation in the aVR lead was very characteristic. This finding was confirmed in 69% of the total patients. Noticeably, 5 out of 6 non-survivors (83%) showed ST elevation not only in leads aVR but also in the aVL lead. In addition to the absence of collateral circulation, this electrocardiographic finding, which obviously indicates the presence of extensive myocardial ischemia in the diseased heart, is a simple and important predictor suggesting a poor prognosis in LMCA-AMI patients. (Jpn Heart J 2000; 41: 571-581) Key words: Total occlusion of the left main coronary artery, Acute myocardial infarction, Prognosis, ST elevation in aVR and aVL leads DUE to the increasing development of cardiac emergency systems including the Coronary Care Unit (CCU) and also early revascularization therapy such as per-

Clinical Features of Emergency Electrocardiography in Patients With Acute Myocardial Infarction Caused by Left Main Trunk Obstruction

“…18,19 Inoue et al did not report ST-segment change in lead aVR in patients with takotsubo cardiomyopathy, which usually causes severe left ventricular (LV) dysfunction and mimics wide anterior MI, despite marked ST-segment elevation or abnormal Q wave in extensive precordial lead. 20 In our ECG analysis, ST-segment elevation in lead aVR in LMT group was significantly higher than in the other 3 groups.…”

Reciprocal Changes in 12-Lead Electrocardiography Can Predict Left Main Coronary Artery Lesion in Patients With Acute Myocardial Infarction

“…Thus, the present results are clinically useful for early recognition of acute LMCA occlusion in patients Several reports have shown that ST segment elevation in leads aVR and V 1 was related to acute LMCA occlusion. 3,4) We also found one report which stated that reciprocal ST segment depression in a 12-lead ECG can predict an acute LMCA lesion. Only two case reports have shown that diffuse ST depression over the inferior and anterior leads are typical ECG manifestations of AMI secondary to an LM occlusion.…”

“…Over the past few years, many reports have shown that ST segment elevation in leads aVR and V 1 is an important predictor of acute LMCA occlusion. 3,4) However, there have been no reports on reciprocal ST segment depression or whether the relationship between ST segment depression differs between acute LMCA and LADCA proximal lesions. Therefore, we undertook this study to compare reciprocal ST segment depression in patients with acute LMCA occlusion with that in patients with acute LADCA occlusion.…”

Thrombotic occlusion of the ostial left main coronary artery in a patient with acute coronary syndrome

“…Many different ECG patterns have been described by authors, either as case reports or as small series. [1][2][3][4] Hori et al described 13 patients with acute myocardial infarction (MI) caused by total occlusion of the LMCA during a period of eight years. 1 ST elevation in lead aVR was present in 69% of patients, and five of the six non-survivors had ST-segment elevation in lead aVR as well as aVL.…”

“…[1][2][3][4] Hori et al described 13 patients with acute myocardial infarction (MI) caused by total occlusion of the LMCA during a period of eight years. 1 ST elevation in lead aVR was present in 69% of patients, and five of the six non-survivors had ST-segment elevation in lead aVR as well as aVL. In a descriptive study of 16 patients by Yamaji et al 2 ST-segment elevation in lead aVR with less elevation in lead V1 proved to be an important predictor of LMCA occlusion in patients admitted within 12 hours of the onset of acute MI, as in our patient.…”