Early, accurate, non-invasive predictors of left main or 3-vessel disease in patients with non-ST-segment elevation acute coronary syndrome.
BACKGROUND
In patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), identification of left main and/or 3-vessel disease (LM/3VD) is crucial for deciding whether to initiate early treatment with clopidogrel, which can increase the risk of surgical bleeding.


RESULTS
On admission, the clinical factors of 501 patients with NSTE-ACS, who underwent coronary angiography, were evaluated. ST-segment shifts and the widest QRS duration were measured on an admission 12-lead electrocardiogram. Ninety-six patients had LM/3VD. Univariate analysis indicated that many factors were related to LM/3VD. On multivariate analysis, QRS duration (odds ratio (OR) 9.04, P<0.01), the degree of ST-segment elevation in lead aVR (OR 7.10, P<0.01), and positive-troponin T (OR 1.52, P<0.05) were independent predictors of LM/3VD. A QRS duration of >90 ms and a ST-segment elevation in lead aVR of >or=0.5 mm best identified LM/3VD. A QRS duration of >90 ms, a ST-segment elevation in lead aVR of >or=0.5 mm, and a positive-troponin T identified LM/3VD with sensitivities of 88%, 76%, and 54% (P<0.01), and specificities of 88%, 86%, and 71% (P<0.01), respectively.


CONCLUSIONS
A prolonged QRS duration, ST-segment elevation in lead aVR, and a positive-troponin T on admission are useful predictors of LM/3VD in patients with NSTE-ACS. In particular, a maximal QRS duration of >90 ms was the most sensitive predictor of LM/3VD.
Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. masami-kosuge@pop06.odn. ne.jp
Masami
M
Kosuge
Toshiaki
T
Ebina
Kiyoshi
K
Hibi
Satoshi
S
Morita
Naohiro
N
Komura
Katsutaka
K
Hashiba
Masayoshi
M
Kiyokuni
Naoki
N
Nakayama
Satoshi
S
Umemura
Kazuo
K
Kimura
D054058:Acute Coronary Syndrome / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077144:Clopidogrel; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D020107:Troponin T / Q000097:blood*
D010975:Platelet Aggregation Inhibitors; D020107:Troponin T; D000077144:Clopidogrel; D013988:Ticlopidine