Retrospective Analysis:Value Of The 12 Lead ECG In Diagnosing Left Main Stem Coronary Artery Disease

Objective: To access the diagnostic value of 12-ECG predictors of left main stem coronary artery disease(LMCA-D).Methods: A total 4914 consecutive patients underwent coronary arteriography for suspected coronary artery disease. 176 patients were included after stratified random sampling and exclusion criteria. Information of the initial history, ECGs and films were blindly analysised by physician, electrophysiologist and interventional cardiologist respectively. 2 groups were divided based on the results of CAG: LMCA-D group and Non-LMCA-D group. Comparatively analyze 2groups to choose the sensitive and specific index.Results: Binary logistic regression analysis indicated that ST-segment elevation in lead a VR≥0.05mv(OR:3.856,P<0.05)and ≥5 leads of ST-segment depression(OR:3.152,P<0.05)were independent predictors of LMCA-D. Combined with ST-segment elevation in lead a VR≥0.05 mv, ≥5 leads of ST-segment depression, ST segment depression in lead V4-V6, general T waves invertion, QRS wave duration>100ms, normal voltage in lead a VF and bundle branch block,the diagnosis of LMCA-D increased from 40.34% to 93.81%.The seven indicators identified LMCA-D with positive predictive values of 66.07%,53.76%,54.67%,48.31%,42.65%,32.65% and 50.00%.Conclusion: ECG is a feasible way of diagnosing LMCA-D, ST-segment elevation in lead a VR≥0.05 mv is indicator well predicting LMCA-D. Combined with multi-indicators can improve the diagnostic value of ECG in LMCA-D.The ECG of LMCA-D can be characterized as ST-segment elevation in lead a VR,Genaral ST segment depression and T waves invertion especially in lead V4-V6、New bundle branch block、ECG of other culprit vessel when complicated with other vessels disease or Normal ECG.