EARLY, NON-INVASIVE PREDICTORS OF LEFT MAIN OR 3- VESSEL DISEASE IN PATIENTS WITH NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROME

Abstract

Background: Acute coronary syndrome remains the leading cause of morbidity and mortality
worldwide .It describes aspectrum of clinical syndromes ranging from unstable angina(UA) and non-
ST-elevation myocardial infarction(NSTEMI) to ST-segment elevation myocardial infarction
(STEMI).
Methods: This study had been done in cardiology department, faculty of Medicine, Zagazig
university during the period from July 2009 to April 2011. The study included fifty patients presented
with NSTE-ACS underwent cardiac catheterization for coronary angiography to diagnose and
evaluate coronary artery disease, among the 50 Patients 34 were male (78%) and 16 were female (22
%). The patients were divided into two groups: Group (1): total number 20,included patients with left
main and/or three vessel disease diagnosed by coronary angiography, (15) males and (5) females with
mean age and standard deviation of 64.2±11.7. Group (2): total number 30,included patients without
left main nor three vessel disease diagnosed by coronary angiography,(19) males and (11) females
with mean age and standard deviation of 53.7±13.3.
• Results: The comparative study among the two groups regarding to the age ,showed statistically
significant difference (p<0.05)where patients in group 1 were older than patients in group 2. The other
population characteristics were comparable in the two studied groups(p>0.05). In the multivariate
logistic regression analysis for variables predicting left main and/or three vessel disease, the maximal
QRS duration more than 90ms was the strongest predictor of left main and /or three vessel disease
followed by ST-segment elevation in lead aVR of >0.5mm.
Conclusion: Despite the development of improved diagnostic strategies,The ECG remains an essential
clinical tool for the evaluation of acute coronary syndrome because it is inexpensive,readly
available,simple,safe and non invasive. Although electrocardiographic assessment of myocardial
ischemia is usually based on ST-segment deviation,QRS prolongation has been showed to be more
sensitive than ST-segment changes for the detection of myocardial ischemia.