Diversity of Electrocardiographic Patterns in Left Main Culprit Acute ST-Elevation Myocardial Infarction.

IF 3.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal Pub Date : 2025-05-14 DOI:10.1016/j.ahj.2025.05.007

B Rai, M Yildiz, S Bergstedt, A Bandari, D Niehaus, A Bae, K R Thao, A Matos, T D Henry, R F Garberich, J Chambers, A Murthy, S W Sharkey, F V Aguirre

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引用次数: 0

Abstract

Background: The clinical implications of diverse electrocardiographic (ECG) findings in acute ST-elevation myocardial infarction (STEMI) patients with left main (LM) culprit are not well understood.

Methods: Using the multicenter Midwest STEMI consortium database of 12,403 patients, we identified 68 (0.5%) with unprotected LM culprits. The activating ECGs (aECG) were classified into three patterns: a) Non-ST-elevation (NSTE); b) ST-elevation (STE); or c) Atypical.

Results: The median age was 68 (IQ percentile: 58-83) years, 67% were male. LM occlusion (TIMI flow: 0-1) was observed in 20 (29%) and sub-occlusive LM (TIMI flow: 2-3) in 48 (71%) patients. Worse in-hospital adverse outcomes (cardiac arrest: 50% vs. 18%, p=0.016; shock: 75% vs. 36%, p=0.007; and death, 75% vs. 44%, p=0.03) occurred among patients with an occlusive versus sub-occlusive LM culprit, respectively. Both a NSTE-type (n=14; 20.5%) and STE-type (n=14; 20.5%) aECG pattern were observed in the minority of patients limiting the diagnostic utility for identifying the presence of LM culprit acute myocardial infarction (aggregate sensitivity: 41%; specificity:71%). A STE-type aECG was more frequently associated with LM occlusion (n=10/14; 71%) compared with either a NSTE- or Atypical-type ECG pattern (10/54; 19%; p=0.001; aggregate sensitivity: 50%, specificity: 92%) and higher adverse in-hospital cardiac events.

Conclusion: Previously reported archetypal ECG patterns associated with LM culprit MI were observed in a minority of patients, limiting thier diagnostic utility. A STE-type pattern more accurately detected the presence of occlusive LM coronary flow and was associated with worse in-hospital outcomes.

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左主犯急性st段抬高型心肌梗死心电图形态的多样性。

背景：急性st段抬高型心肌梗死（STEMI）左主干（LM）患者不同心电图（ECG）表现的临床意义尚不清楚。方法：使用多中心中西部STEMI联盟数据库的12,403例患者，我们确定了68例（0.5%）未保护的LM罪魁祸首。激活心电图（aECG）分为3种模式：a)非st段抬高（NSTE）；b) st段抬高（STE）；c)非典型的。结果：年龄中位数为68岁（IQ百分位数：58 ~ 83），男性占67%。20例（29%）患者出现LM闭塞（TIMI流量：0-1），48例（71%）患者出现LM亚闭塞（TIMI流量：2-3）。更糟糕的院内不良结局(心脏骤停：50%对18%，p=0.016；休克：75% vs. 36%, p=0.007；闭塞性和亚闭塞性LM罪魁祸首患者的死亡率分别为75%和44% （p=0.03）。均为nste型(n=14；20.5%)和ste型(n=14；20.5%)在少数患者中观察到aECG模式，限制了识别LM罪魁祸首急性心肌梗死存在的诊断效用(总敏感性：41%；特异性:71%)。ste型aECG更常与LM闭塞相关(n=10/14；71%)与非典型型或非典型型心电图模式(10/54；19%;p = 0.001;总敏感性：50%，特异性：92%)和更高的不良住院心脏事件。结论：先前报道的与LM罪魁祸首心肌梗死相关的原型ECG模式在少数患者中观察到，限制了他们的诊断效用。ste型更准确地检测到LM冠状动脉阻塞血流的存在，并与较差的住院结果相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American heart journal 医学-心血管系统

CiteScore

8.20

自引率

2.10%

发文量

214

审稿时长

38 days

期刊介绍： The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.