Electrocardiographic characteristics associated with in-hospital outcome in patients with left main acute coronary syndrome: For contriving a new risk stratification score. Issue 3 (April 2018)

• Record Type: Journal Article
• Authors: Iida, Takayuki; Tanimura, Fumito; Takahashi, Kyoko; Nakamura, Hideki; Nakajima, Satoshi; Nakamura, Motoyuki; Morino, Yoshihiro; Itoh, Tomonori
• Is Part Of: European heart journal. Volume 7:Issue 3(2018)
• Page Start: 200
• Page End: 207
• Publication Date: 2018-04
• Subjects: Acute coronary syndrome -- left main -- in-hospital mortality -- electrocardiography; 616.1205
• DOI: 10.1177/2048872616683524
• Languages: English
• ISSNs: 2048-8726

Abstract

Aim: The aim of this study was to evaluate electrocardiographic characteristics associated with in-hospital prognosis in patients with left main acute coronary syndrome. Methods and results: A total of 89 left main acute coronary syndrome subjects were selected from 3357 consecutive acute coronary syndrome patients (2.7%). Patients of this study were divided into two groups; those who survived and those who died. Patients' characteristics and electrocardiogram on admission were then retrospectively analyzed between the two groups. In-hospital mortality was 28.1%. The prevalence and degree of ST-segment elevation at lead aVL were significantly higher in the deceased group than in the survival group ( p <0.001). However, those at lead aVR did not show significant differences between the two groups. Moreover, the width of the QRS-complex was significantly wider (lead V3; p <0.001), and the level of five minus the absolute value of five minus number of ST-segment elevation (5–|5–ST|; due to the highest in-hospital mortality (70%) in the five-lead ST-segment elevation group) was significantly larger in the deceased group than in the survival group ( p <0.001). The odds ratios that predicted in-hospital cardiac death were 1.03 for width of the QRS-complex at lead V3 (95% confidence interval (CI); 1.01–1.06; p =0.003), 1.74 for 5–|5–ST| (95% CI; 1.03–3.00; p =0.040), and 1.44 for ST-segment elevation at lead aVL (95% CI; 0.93–2.23; p =0.100). Conclusions: ST-segment elevation at lead aVL rather than aVR, width of the QRS-complex at lead V3 and number of ST-segment elevation were the prognostic predictors for in-hospital mortality in patients with left main acute coronary syndrome. Electrocardiographic characteristics should be assessed in addition to the established risk score in patients with left main acute coronary syndrome.