Introduction

Acute total occlusion of the left main coronary artery (ATOLMA) usually leads to a catastrophic presentation. Prediction of ATOLMA by electrocardiogram (ECG) may contribute to early detection and reperfusion. Limited data have been reported previously. This study aims to identify the admission 12‑leads ECG features that can predict the presence of ATOLMA and in-Hospital mortality in these patients.

Methods

The admission ECGs findings in 24 patients from the previously reported ATOLMA multicenter registry were compared to the ECGs findings in 15 patients with an acute subtotal occlusion of the left main (ASOLMA) and to 15 patients with anterior ST-elevation myocardial infarction of the proximal left anterior descending (LADp-STEMI).

Results

Some ECG features at presentation can predict an ATOLMA: QRS left axis deviation (−61.17 ± 9 degrees); ST-segment elevation in aVL (1.9 ± 0.65 mm); absence of ST-segment elevation in V1 (0.0 ± 0.6 mm); bifascicular block (58%); fragmented QRS (62.5%); prolongation of QTc interval (465 ± 19 ms) and of QRS interval (136 ± 12 mm). The multivariate analysis found that the independent predictors to distinguish ATOLMA from ASOLMA were aVL ST-segment deviation (OR 5.6(95% CI 1.5–21), p = 0.01) and absence of V1 ST-segment elevation (OR 27(95% CI 1.4–52), p = 0.01); and from LADp-STEMI was QRS width (OR 1.1(95% CI 1.02–1.2), p = 0.02). Fragmented QRS was the only independent predictor of in-hospital mortality in ATOLMA (OR 0.125(95% CI 0.01–0.81), p = 0.03).

Conclusions

aVL ST-segment elevation, the absence of V1 ST-segment elevation, left axis deviation, the presence of bifascicular block, and prolongation of QRS and QTc interval are predictors of ATOLMA. Fragmented QRS predicts in-hospital mortality in ATOLMA.

中文翻译：

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真正急性左主干冠状动脉完全闭塞的心电图结果来自 ATOLMA 注册的子分析

介绍

左冠状动脉主干 (ATOLMA) 的急性完全闭塞通常会导致灾难性的表现。通过心电图 (ECG) 预测 ATOLMA 可能有助于早期检测和再灌注。之前报告的数据有限。本研究旨在确定入院 12 导联心电图特征，这些特征可以预测这些患者是否存在 ATOLMA 和院内死亡率。

方法

将之前报道的 ATOLMA 多中心登记中 24 名患者的入院心电图结果与 15 名左主干急性次全闭塞 (ASOLMA) 患者和 15 名左近端 ST 段抬高心肌梗死患者的心电图结果进行比较前降序 (LADp-STEMI)。

结果

演示时的一些心电图特征可以预测 ATOLMA： QRS 轴左偏（-61.17 ± 9 度）；aVL 中的 ST 段抬高 (1.9 ± 0.65 mm)；V1 无 ST 段抬高 (0.0 ± 0.6 mm)；双分支阻滞（58%）；碎裂 QRS (62.5%); QTc 间期延长 (465 ± 19 ms) 和 QRS 间期延长 (136 ± 12 mm)。多变量分析发现，区分 ATOLMA 和 ASOLMA 的独立预测因子是 aVL ST 段偏差（OR 5.6（95% CI 1.5-21），p = 0.01）和不存在 V1 ST 段抬高（OR 27（95% CI） 1.4–52), p = 0.01); 来自 LADp-STEMI 的是 QRS 宽度（OR 1.1（95% CI 1.02–1.2），p = 0.02）。碎裂 QRS 是 ATOLMA 院内死亡率的唯一独立预测因子（OR 0.125（95% CI 0.01–0.81），p = 0.03）。

结论

aVL ST 段抬高、无 V1 ST 段抬高、电轴左偏、存在双分支阻滞以及 QRS 和 QTc 间期延长是 ATOLMA 的预测因素。碎片 QRS 波预测 ATOLMA 的院内死亡率。