ST-elevation in precordial leads major predictor in acute total left main occlusion, study finds

2. Nineteen individuals had ST-segment elevation myocardial infarction (STEMI), while 25 had non-ST-segment elevation myocardial infarction (NSTEMI).

3. The absence of collateral circulation was linked with ST-segment elevation (STE) in I and STEMI, whereas the presence of collateral circulation was associated with STE in aVR.

4. Patients with STE in both aVR and aVL in the NSTEMI group had a greater collateral filling of the left anterior descending coronary artery (LAD) region, whereas patients with STE in aVR had a greater collateral filling of the LAD and the left circumflex artery territory.

5. Patients with partial ULM obstruction had greater STE in aVR, less STE in aVR and aVL, and less STEMI than patients with entire ULM occlusion.

6. Shock, TIMI 0–2 flow after PCI, non-STE in aVR, STEMI, and STE in I all predicted in-hospital death.

7. STEMI and the lack of collateral flow were both linked with shock.

In conclusion, STE in both aVR and aVL leads is a good sign for distinguishing entire ULM obstruction from partial ULM occlusion. Patients who report with STE in both channels aVR and aVL should be identified as high-risk and undergo immediate coronary angiography.

Reference:

Liu, C., Yang, F., Zhang, J. et al. Electrocardiographic patterns predict the presence of collateral circulation and in-hospital mortality in acute total left main occlusion. BMC Cardiovasc Disord 22, 144 (2022). https://doi.org/10.1186/s12872-022-02585-x