title: Prediction of left main coronary artery obstruction by 12-lead electrocardiography: ST segment deviation in lead V6 greater than or equal to ST segment deviation in lead V1.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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).
authors.affiliation: Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA. nmahajan@maimonidesmed.org
authors.forename: Nitin
authors.initials: N
authors.lastname: Mahajan
authors.forename: Gerald
authors.initials: G
authors.lastname: Hollander
authors.forename: Deepak
authors.initials: D
authors.lastname: Thekkoott
authors.forename: Brian
authors.initials: B
authors.lastname: Temple
authors.forename: Bilal
authors.initials: B
authors.lastname: Malik
authors.forename: Sunil
authors.initials: S
authors.lastname: Abrol
authors.forename: David
authors.initials: D
authors.lastname: Yens
authors.forename: Jacob
authors.initials: J
authors.lastname: Shani
authors.forename: Edgar
authors.initials: E
authors.lastname: Lichstein
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors