Electrocardiographic Left Ventricular Hypertrophy as a Predictor for Nonsignificant Coronary Artery Disease in Patients With Non-ST-Segment Elevation Myocardial Infarction.
Left ventricular hypertrophy (LVH) can lead to subendocardial ischemia by altering the coronary blood flow and its transmural myocardial distribution in the setting of increased oxygen demand. We hypothesized that electrocardiographic LVH predicts nonsignificant coronary artery disease (CAD) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). We performed a retrospective analysis of 406 consecutive patients with NSTEMI who underwent coronary angiography. The LVH was diagnosed using Sokolow-Lyon and Cornell voltage criteria. Nonsignificant CAD was defined as stenosis less than 50% in the left main and 70% in any other coronary arteries. Of the 406 patients, 100 (25%) patients had electrocardiographic LVH and 99 (24%) patients had nonsignificant CAD. Patients with electrocardiographic LVH had a higher prevalence of nonsignificant CAD (32% vs 22%, P = .04) and a lower rate of in-hospital revascularization (45% vs 69%, P < .001) than those without LVH. On multivariate analysis, electrocardiographic LVH was an independent predictor of nonsignificant CAD (odds ratio 1.94; 95% confidence interval 1.12-3.35; P = .02). In conclusion, electrocardiographic LVH is an independent predictor of nonsignificant CAD and associated with a lower rate of in-hospital revascularization in patients with NSTEMI.
Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY, USA nmisumida@chpnet.org.
Naoki
N
Misumida
Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY, USA.
Akihiro
A
Kobayashi
Department of Cardiology, Mount Sinai Beth Israel, New York, NY, USA.
Madeeha
M
Saeed
Department of Cardiology, Mount Sinai Beth Israel, New York, NY, USA.
John T
JT
Fox
Department of Cardiology, Mount Sinai Beth Israel, New York, NY, USA.
Yumiko
Y
Kanei
D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
left ventricular hypertrophy; non-ST-segment elevation myocardial infarction; nonsignificant coronary artery disease