Diversity of electrocardiographic patterns in left main culprit acute ST-elevation myocardial infarction
Authors' conclusion
Previously reported archetypal ECG patterns associated with LM culprit MI were observed in a minority of patients, limiting their diagnostic utility. A STE-type pattern more accurately detected the presence of occlusive LM coronary flow and was associated with worse in-hospital outcomes.
Study context
- Population
- ST-elevation myocardial infarction (STEMI) patients with unprotected left main (LM) culprit, Midwest STEMI consortium databaseof 12,403 in database
- Participants
- 68 patients
- Exposure
- Activating electrocardiographic (ECG) patterns in LM culprit STEMI
- Non-ST-elevation (NSTE)n = 14
- ST-elevation (STE)n = 14
- Outcome
- Diagnostic performance of aECG patterns
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
| Group | Value | LM occlusion detection sensitivity | LM occlusion detection specificity |
|---|---|---|---|
| STE | 71% | 50% | 92% |
| NSTE or Atypical | 19% |
Value
STE71%
NSTE or Atypical19%
LM occlusion detection sensitivity
STE50%
NSTE or Atypical— not stated in the abstract
LM occlusion detection specificity
STE92%
NSTE or Atypical— not stated in the abstract
- STE vs NSTE or Atypical: P = 0.001
- NSTE and STE patterns for LM culprit: aggregate sensitivity
- 41%
- NSTE and STE patterns for LM culprit: aggregate specificity
- 71%
Observational data: associations, not effects.
Further findings
In-hospital outcomes, occlusive vs sub-occlusive LM culprit
Cardiac arrest
Shock
Death
- In-hospital outcomes, occlusive vs sub-occlusive LM culprit: cardiac arrest P = .016
- In-hospital outcomes, occlusive vs sub-occlusive LM culprit: shock P = .007
- In-hospital outcomes, occlusive vs sub-occlusive LM culprit: death P = .03
Original publication
Diversity of electrocardiographic patterns in left main culprit acute ST-elevation myocardial infarction. Am Heart J. Published 14 May 2025. doi:10.
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