Differences in initial electrocardiographic findings between ST-elevation myocardial infarction due to left main trunk and left anterior descending artery lesions

Toshiharu Fujii; Misaki Hasegawa; Junichi Miyamoto; Yuji Ikari

doi:10.1186/s12245-019-0227-x

Differences in initial electrocardiographic findings between ST-elevation myocardial infarction due to left main trunk and left anterior descending artery lesions

Int J Emerg Med. 2019 Apr 5;12(1):12. doi: 10.1186/s12245-019-0227-x.

Authors

Toshiharu Fujii¹, Misaki Hasegawa¹, Junichi Miyamoto¹, Yuji Ikari²

Affiliations

¹ Department of Cardiology, Division of Cardiovascular Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan.
² Department of Cardiology, Division of Cardiovascular Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan. ikari@is.icc.u-tokai.ac.jp.

Abstract

Background: Early discrimination of ST-elevation myocardial infarction (STEMI) due to a left main trunk (LMT) lesion provided by straightforward electrocardiographic criteria is useful for prompt treatment. The purpose of this study is to investigate differences in electrocardiographic findings between STEMI due to lesions of LMT and those of left anterior descending artery (LAD).

Methods: Initial electrocardiogram (ECG) recordings of 435 patients with analyzable ECGs from a cohort of 940 consecutive STEMI patients were analyzed retrospectively for presence of LMT lesions (LMT, n = 39), proximal (pLAD, n = 224) and distal LAD lesions (dLAD, n = 172). ST-segment deviations in 12 leads were assessed among 3 groups without bundle branch block (n = 17 in LMT, n = 180 in pLAD, and n = 159 in dLAD).

Results: Magnitudes of ST-segment deviations showed significant differences in leads II, III, aVR aVL, aVF, and V2-V6 across the three groups. This difference suggested two possible characteristic findings in the LMT group, allowing it to be distinguished from the pLAD or dLAD group; (A) larger magnitude of ST-segment depression in lead II than that of ST-segment elevation in lead V2 (47.1% in LMT vs. 0.6% in pLAD vs. 1.3% in dLAD, P < 0.0001), and (B) ST-segment depression in lead V5 (58.8% in LMT vs. 6.7% in pLAD vs. 2.5% in dLAD, P < 0.0001). These findings exhibited superior negative predictive value over conventional ST-segment elevation in lead aVR.

Conclusions: A large reciprocal ST-segment depression in inferior leads and ST-segment depression in lead V5 are useful ECG findings allowing determination of STEMI due to an LMT lesion.

Keywords: Electrocardiography; Left anterior descending artery; Left main trunk; ST-elevation myocardial infarction; ST-segment depression; ST-segment elevation.