Tips from Other Journals

Predicting Left Main Stenosis in Resting Angina Pectoris



FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.


FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.

Am Fam Physician. 2004 May 1;69(9):2228.

Significant left main coronary artery disease in patients with acute coronary syndrome (ACS) generally is managed with bypass surgery. Treatment before surgery often includes anti-platelet therapy using a combination of aspirin and clopidogrel. Clopidogrel therapy seems to improve clinical outcomes in patients with ACS but may lead to increased morbidity, especially among patients who undergo 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 need 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 V1, 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 V1. Clopidogrel therapy was withheld in these patients, and emergency angiography was performed, which confirmed significant left main disease. All patients were successfully 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, such as left circumflex artery stenosis, right coronary artery stenosis, vessel dominance, or prior myocardial infarction.

The authors conclude that an aVR ST-segment elevation greater than the V1 ST-segment elevation can predict left main stenosis in patients with ACS, and its early recognition can improve clinical outcomes in these patients.

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



Copyright © 2004 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Article Tools

  • Print page
  • Share this page
  • AFP CME Quiz

Information From Industry

Navigate this Article