title: Electrocardiographic presentation of left main disease in patients undergoing urgent or emergent coronary artery bypass grafting.
abstract: BACKGROUND
  Widespread ST-segment depression with inverted T waves maximally in leads V4-V5 (ie, the global ischemia electrocardiogram [ECG] pattern) is a marker of adverse outcome in patients with non-ST-segment elevation acute coronary syndrome (ACS), perhaps because this pattern is indicative of left main stem stenosis. However, the prognostic value of this ECG pattern has not yet been established.
  
  
  OBJECTIVE
  We studied the predictive value of a prespecified ECG pattern in patients who underwent urgent or emergent coronary artery bypass grafting (CABG).
  
  
  METHODS
  We studied the sensitivity, specificity, and predictive values for the global ischemia ECG to predict angiographic left main coronary artery disease. Patients with a 12-lead ECG recorded during anginal symptoms before CABG were included.
  
  
  RESULTS
  The global ischemia ECG pattern was found in 61 (76%) of 80 patients with and 12 (19%) of 65 patients without left main disease. The sensitivity, specificity, and positive and negative predictive values for left main coronary artery disease in patients with the global ischemia ECG pattern were 76%, 81%, 84%, and 74%, respectively. In multivariate analysis, the global ischemia ECG pattern was strongly associated with angiographic left main coronary artery disease after adjusting for age, gender, diabetes, hypertension, and smoking (hazard ratio, 16.0; 95% confidence interval, 6.5-39.5; P < 0.001).
  
  
  CONCLUSIONS
  The global ischemia ECG pattern was strongly associated with angiographic left main coronary artery disease in patients who underwent urgent or emergent CABG.
authors.affiliation: Heart Center, Tampee University Hospital, Tampere, Finland. kjell.nikus@sydankeskus.fi
authors.forename: Kjell
authors.initials: K
authors.lastname: Nikus
authors.forename: Otso
authors.initials: O
authors.lastname: Järvinen
authors.forename: Samuel
authors.initials: S
authors.lastname: Sclarovsky
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.forename: Matti
authors.initials: M
authors.lastname: Tarkka
authors.forename: Markku
authors.initials: M
authors.lastname: Eskola
mesh_terms: D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D004562:Electrocardiography; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012680:Sensitivity and Specificity; D012737:Sex Factors; D018709:Statistics, Nonparametric