Predictors of Left Main or Three-Vessel Disease in Patients Who Have Acute Coronary Syndromes With Non–ST-Segment Elevation

Early, Accurate, Non-Invasive Predictors of Left Main or 3-Vessel Disease in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome

“…[7][8][9] Troponin T on admission is a well-established marker of high risk in patients with NSTE-ACS, 18,19 whereas ST-segment elevation in lead aVR is more useful for identifying patients with LM/3VD. The results of the Troponin T was positive on admission.…”

“…Early (ie, before angiography), accurate, non-invasive identification of patients with LM/3VD in whom CABG is most likely to be indicated is thus a major clinical issue with important therapeutic implications. We have previously demonstrated that ST-segment elevation in lead aVR and positive-troponin T on admission (especially the former) are useful predictors of the risk of LM/3VD in patients with NSTE-ACS, [7][8][9] however, QRS duration in previous studies was not considered. Although electrocardiographic assessment of myocardial ischemia is usually based on ST-segment deviation, QRS prolongation has been shown to be more sensitive than ST-segment changes for the detection of myocardial ischemia.…”

ST‐segment Elevation in Lead Augmented Vector Right may also be Caused by Diffuse Left Main Coronary Artery Vasospasm Without Fixed Stenosis

“…From the study, the sensitivity of ST-segment elevation in lead aVR for predicting LMCA obstruction was determined to be 81% and the specificity to be 80%. Kosuge et al 1 found that STsegment elevation greater than 0.5 mm in lead aVR to be the strongest predictor of LMCA or three-vessel disease, superior to the presence of ST-segment depression in other leads in patients with non-ST-segment elevation-ACSs who underwent coronary angiography in the acute phase. Statistical analysis of this finding revealed a sensitivity of 78%, a specificity of 86%, a positive predictive value of 57%, and a negative predictive value of 95%.…”

Updates on the Electrocardiogram in Acute Coronary Syndromes

“…There were 475 who underwent angiography; of those with C1 mm of STE in aVR (n = 92), 48 % had three-vessel disease and 18 % had LMCA disease, compared to 21 and 4 % for those with \1 mm STE in aVR [74]. Kosuge et al [75] studied 310 patients with ACS without STE. They found that STE in aVR of C0.5 mm was the strongest predictor of LMCA or three-vessel disease, with an OR of 19.7, and it identified LMCA or three-vessel disease with 78 % sensitivity and 86 % specificity, and a PPV and NPV of 57 and 95 %.…”

“…More recent claims that ST elevation in aVR is independent of ST depression in these opposing leads have not been substantiated for non-STEMI, though this appears to be true for STEMI (see above). Nevertheless, it is convenient to use one lead with ST elevation (aVR) as a substitute for many others with ST depression, such that, in non-STE-ACS, the degree of ST elevation in aVR correlates with the number of leads with ST depression, the depth of the ST depression, and the sum of ST depressions [67,[73][74][75][76]. In all studies, measurements of the ST segment are at 80 ms after the J-point for ST depression and 20 ms after the J-point for ST elevation, both relative to the TP segment.…”