Mahajan Nitin, Hollander Gerald, Thekkoott Deepak, Temple Brian, Malik Bilal, Abrol Sunil, Yens David, Shani Jacob, Lichstein Edgar
Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA.
Ann Noninvasive Electrocardiol. 2006 Apr;11(2):102-12. doi: 10.1111/j.1542-474X.2006.00090.x.
Acute coronary syndrome (ACS) resulting from culprit lesion in left main coronary artery (LMCA) can cause rapid hemodynamic deterioration. It is important to identify these patients early to facilitate timely revascularization. ST segment elevation in aVR greater than or equal to V(1) (aVR-V(1)>or= 0) has been suggested as a sensitive predictor of LMCA disease. As a result of balanced forces, we hypothesized that ST deviation in V(6) greater than or equal to ST deviation in V(1) (V(6)-V(1)>or= 0) might be a good determinant of LMCA disease.
We compared admission 12-lead ECGs of ACS resulting from culprit LMCA lesion (n = 75, group I) with ACS resulting from culprit left anterior descending lesion (n = 81, group II). Group I was selected over a period of 10 years. We compared V(6)-V(1)>or= 0 to aVR-V(1)>or= 0 in both groups. We also looked at ratios of ST deviations in V(6),V(1) (V(6)/V(1)>or= 1) and aVR,V(1) (aVR/V(1)>or= 1) in patients where ST segment in V(1) was not isoelectric (group I = 54 and group II = 55).
ST deviation in V(6) was significantly greater in group I as compared to group II (P < 0.001). The reliabilities of V(6)-V(1)>or= 0, V(6)/V(1)>or= 1, aVR-V(1)>or= 0, and aVR/V(1)>or= 1 in predicting LMCA disease were determined.
This is the largest series of ECG analysis on ACS resulting from culprit LMCA lesion. V(6)-V(1)>or= 0 and V(6)/V(1)>or= 1 were more sensitive in predicting LMCA as culprit vessel in comparison to previously reported greater ST segment elevation in aVR than V(1).
左主干冠状动脉（LMCA）罪犯病变导致的急性冠状动脉综合征（ACS）可引起血流动力学迅速恶化。早期识别这些患者以促进及时血运重建很重要。有人提出aVR导联ST段抬高大于或等于V1导联（aVR-V1≥0）是LMCA疾病的敏感预测指标。由于力的平衡，我们假设V6导联ST段偏移大于或等于V1导联ST段偏移（V6-V1≥0）可能是LMCA疾病的良好判定指标。
我们比较了由LMCA罪犯病变导致的ACS患者（n = 75，I组）与由左前降支罪犯病变导致的ACS患者（n = 81，II组）的入院12导联心电图。I组是在10年期间选取的。我们比较了两组中V6-V1≥0与aVR-V1≥0的情况。我们还观察了V1导联ST段非等电位线的患者中V6、V1导联ST段偏移比值（V6/V1≥1）以及aVR、V1导联ST段偏移比值（aVR/V1≥1）（I组 = 54例，II组 = 55例）。
与II组相比，I组V6导联ST段偏移显著更大（P < 0.001）。确定了V6-V1≥0、V6/V1≥1、aVR-V1≥0和aVR/V1≥1在预测LMCA疾病方面的可靠性。
这是关于由LMCA罪犯病变导致的ACS的最大规模心电图分析系列研究。与先前报道的aVR导联ST段抬高大于V1导联相比，V6-V1≥0和V6/V1≥1在预测LMCA为罪犯血管方面更敏感。
