Key result
Admission ST elevation in acute left circumflex occlusion linked to ~443% higher 30-day MACE risk.
Why the study?
Does the admission ECG pattern predict clinical outcomes and angiographic characteristics in patients with acute left circumflex coronary occlusion?
Cohort (n=314)
Does the admission ECG pattern predict clinical outcomes and angiographic characteristics in patients with acute left circumflex coronary occlusion?
Effect estimate: OR 5.43 (95% CI 1.09-27.20)
In patients with acute left circumflex occlusion, admission ECG patterns identify distinct clinical and prognostic profiles, highlighting the need for prompt reperfusion and the use of posterior leads (V7-V9) in those with isolated precordial ST-depression.
ST-elevation may flag higher 30-day MACE risk in LCx occlusion; leaves open whether ECG patterns should guide triage or posterior-lead use.
The utility of the electrocardiogram (ECG) in patients with acute left circumflex (LC) coronary occlusion is not established. This study aimed at determining the clinical, angiographic, and prognostic characteristics associated with the different patterns of ST-segment changes in patients with LC occlusion. A cohort of 314 patients with LC occlusion was categorized according to the admission ECG: (1) ST-segment elevation (ST-E, n=208), (2) isolated ST-segment depression in precordial leads (ST-D, n=62), and (3) negligible ST-segment changes (No-ST, n=44). Clinical variables, coronary angiography, and 30-day major adverse cardiac event (MACE) (in-hospital ventricular fibrillation, 1-month mortality, or heart failure) were compared among the three groups. As compared with No-ST, patients with ST-E or ST-D presented more advanced Killip class, higher troponin peak, lower LV ejection fraction, and were independently associated with MACE (odds ratio 5.43, 95% confidence interval 1.09 to 27.20 and odds ratio 3.39, 95% confidence interval 0.66 to 17.50, respectively). Patients with ST-D were tardily reperfused, had more often mitral regurgitation (23.1% vs 9.3% in ST-E and 3.3% in No-ST, p=0.03), and presented ST-segment elevation in leads V7 to V9 in 12 of 16 cases with available recordings. Culprit proximal LC predominated in ST-D (41.9%), distal LC in ST-E (42.8%), and obtuse marginal in No-ST (59.1%) (all p<0.01). The No-ST had smaller coronary vessels and more collaterals. In conclusion, the three ST-segment patterns of LC occlusion identify patients with different clinical, angiographic, and prognostic characteristics. Patients with ST-depression pattern require a prompt reperfusion therapy and could be better recognized by recording leads V7 to V9.
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Vives‐Borrás et al. (2017) conducted a cohort in Acute occlusion of the left circumflex coronary artery (n=314). ST-segment elevation (ST-E) on admission ECG vs. Negligible ST-segment changes (No-ST) was evaluated on 30-day major adverse cardiac event (in-hospital ventricular fibrillation, 1-month mortality, or heart failure) (OR 5.43, 95% CI 1.09-27.20). ST-segment elevation on admission ECG in acute left circumflex occlusion was associated with a higher risk of 30-day MACE compared to negligible ST changes (OR 5.43; 95% CI 1.09-27.20).
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