Electrocardiographic characteristics associated with in-hospital outcome in patients with left main acute coronary syndrome: For contriving a new risk stratification score

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.

Keywords

Acute coronary syndrome left main in-hospital mortality electrocardiography

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