Significant left main coronary arte...

Significant left main coronary artery disease in patients with acute coronary syndrome (ACS) generally is managed with bypass surgery Treatment before surgery oftentimes includes anti-platelet therapy using a combination of aspirin and clopidogrel. Clopidogrel therapy appears to improve clinical outcomes in patients with ACS if it were not that may lead to increased morbidity, especially among patients who sustain bypass surgery. Avoiding the use of clopidogrel five days before surgery may be associated with decreased morbidity, making it more important to identify patients with ACS who may ne to have cardiovascular surgery at an early stage. Gaitonde and associates studied the use of electrocardiographic (ECG) evidence, specifically a lead aVR ST-segment elevation greater than the ST-segment elevation seen in lead [Vsub1] in predicting significant left main coronary artery disease.

ECG changes in four patients presenting with ACS demonstrated ST-segment elevation in lead aVR that was greater than ST-segment elevations in lead [Vsub1] Clopidogrel therapy was withheld in these patients, and sudden [i]or[/i] unexpected occurrence angiography was performed, which confirmed significant left main disease. All patients were favorably treated with emergency coronary bypass surgery

Vectorcardiography may explain the ECG changes seen in patients with ACS. Vectors of different myocardial areas counteract forces from other areas, resulting in the final electrocardiographic tracing. It is unclear whether the same ECG changes would be seen in patients with left main disease who also have other factors that can affect ECG vectors, of the like kind as left circumflex artery stenosis, right coronary artery stenosis, canal dominance, or prior myocardial infarction.

The authors finish that an aVR ST-segment elevation greater than the [Vsub1] ST-segment elevation can predict left main stenosis in patients with ACS, and its early recognition can improve clinical issues in these patients.

Gaitonde R et al. Prediction of significant left main coronary artery stenosis on the 12-lead electrocardiogram in patients with stop angina pectoris and the withholding of clopidogrel therapy. Am J Cardiol October 1 2003;92: 846-8

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