Kosuge et al identified changes in the electrocardiogram associated with left main or triple vessel coronary artery disease in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The authors are from Yokohama City University Medical Center.
Patient selection: non-ST-segment elevation ACS
Parameters:
(1) QRS duration in milliseconds
(2) ST segment elevation in lead aVR in mm
(3) serum troponin T
Parameter |
Finding |
OR |
QRS duration |
<= 90 milliseconds |
1 |
|
> 90 milliseconds |
33.4 |
ST segment elevation in lead aVR |
< 0.5 mm |
1 |
|
>= 0.5 mm |
8.2 |
serum troponin T |
normal |
1 |
|
elevated |
1.7 |
cumulative odds ratio =
= PRODUCT(OR for all 3 parameers)
Interpretation:
• If none of the risk factors are present then the risk of left mean or triple vessel coronary artery disease is low.
• If all 3 factors are present then the risk is high.
Performance:
• The prolongation in QRS duration has a sensitivity of 88% and specificity of 88%. It has a 97% negative predictive value. A QRS prongation > 100 ms was 99% specific.
• A large elevation in aVR may mean that the patient can no longer be classified as non-ST segment elevation.
Specialty: Cardiology
ICD-10: ,