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Prediction of acute left main coronary artery obstruction by 12-lead electrocardiography

ST segment elevation in lead aVR with less ST segment elevation in lead V₁

Hirosuke Yamaji, MD^* , Kohichiro Iwasaki, MD, Shozo Kusachi, MD^*,* , Takashi Murakami, MD^*, Ryouichi Hirami, MD^*, Hiromi Hamamoto, MD^*, Kazuyoshi Hina, MD, Toshimasa Kita, MD, Noburu Sakakibara, MD and Takao Tsuji, MD^*

^* Department of Internal Medicine I, Faculty of Medicine, Okayama, Japan
Department of Medical Technology, Faculty of Health Sciences, Okayama University Medical School, Okayama, Japan
Cardiovascular Center, Sakakibara Hospital, Okayama, Japan

View larger version (46K): [in a new window]   Figure 1 Representative 12-lead electrocardiogram tracings at admission in a patient in (A) the left main coronary artery (LMCA) group, (B) the left anterior descending coronary artery (LAD) group and (C) the right coronary artery (RCA) group. In the patient in the LMCA group, ST segment elevation is apparent in lead aVR. In the patient in the LAD group, marked ST segment elevation in the precordial leads is seen, whereas a ST segment shift in lead aVR is negligible. In the patient in the RCA group, ST segment elevation in the inferior leads is marked.

View larger version (47K): [in a new window]   Figure 2 The incidences of ST segment elevation in each lead in the left main coronary artery (LMCA) group (n = 16; solid bars), left anterior descending coronary artery (LAD) group (n = 46; hatched bars) and right coronary artery (RCA) group (n = 24; dotted bars). *p < 0.05. **p < 0.01.