Prediction of Significant Left Main Coronary Artery Disease using ST-segment Elevation in aVR Among Adult Patients with Acute Coronary Syndrome Admitted at a Tertiary Hospital from January 2011 through December 2015

Abstract

Introduction: This study aims to determine whether ST-segment elevation in aVR predicts significant left main coronary artery (LMCA) disease among adult patients with acute coronary syndrome (ACS). Method: This retrospective study enrolled adult patients, aged 18 years and above, who were diagnosed with ACS, have undergone coronary angiogram, with retrievable electrocardiogram tracings, and were admitted at a tertiary hospital from January 1, 2011 through December 31, 2015. Results: A total of 276 patients were included in the study, majority of them were male, and the mean age was 60+12 years. Forty-three patients had significant LMCA disease, 18 with ST-segment elevation in aVR; 24 patients had no significant LMCA involvement, with ST-segment elevation in aVR; and 209 had no significant left main disease and did not show ST-segment elevation in aVR. Conclusion: The study showed that ST-segment elevation of 0.13 mV in aVR has a sensitivity of 92.9%, specificity of 2.1%, likelihood ratio of 0.95, positive predictive value (PPV) of 14.6% and negative predictive value (NPV) of 62.5% in predicting a significant LMCA disease. ST elevation in aVR has high sensitivity but low specificity, LPV and NPV for predicting significant LMCA disease. Keywords: ECG changes in left main coronary artery disease, ST-segment elevation in aVR.