title: Value of the electrocardiogram in diagnosing the number of severely narrowed coronary arteries in rest angina pectoris.
abstract: The aim of this study was to assess the value of the electrocardiogram recorded during chest pain for identifying high-risk patients with 3-vessel or left main stem coronary artery disease (CAD). Therefore, the number of leads with abnormal ST segments, the amount of ST-segment deviation, and specific combinations of leads with abnormal ST segments were correlated with the number of coronary arteries with proximal narrowing of > 70%. Electrocardiograms recorded during chest pain were compared with one from a symptom-free episode. In this retrospective analysis, 113 consecutive patients were included. One-vessel CAD was present in 47 patients, 2-vessel CAD in 22, 3-vessel CAD in 24 and left main CAD in 20. Stratification was performed according to the presence of an old myocardial infarction. The number of leads with ST-segment deviations, and the amount of ST-segment deviation in the electrocardiogram obtained during chest pain at rest showed a positive correlation with the number of diseased coronary arteries. These findings were more marked when the absolute shifts from baseline were considered, because ST-segment abnormalities could be present also in the electrocardiogram obtained during the symptom-free episode. Left main and 3-vessel CAD showed a frequent combination of leads with abnormal ST segments: ST-segment depression in leads I, II and V4-V6, and ST-segment elevation in lead aVR. The negative predictive and positive accuracy of this pattern were 78 and 62%, respectively. When the total amount of ST-segment changes was > 12 mm, the positive predictive accuracy for 3-vessel or left main stem CAD increased to 86%.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Cardiology, Academic Hospital Maastricht, Cardiovascular Research Institute Maastricht, The Netherlands.
authors.forename: A P
authors.initials: AP
authors.lastname: Gorgels
authors.forename: M A
authors.initials: MA
authors.lastname: Vos
authors.forename: R
authors.initials: R
authors.lastname: Mulleneers
authors.forename: C
authors.initials: C
authors.lastname: de Zwaan
authors.forename: F W
authors.initials: FW
authors.lastname: Bär
authors.forename: H J
authors.initials: HJ
authors.lastname: Wellens
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000209:etiology*; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies