Clinical Features of Emergency Electrocardiography in Patients With Acute Myocardial Infarction Caused by Left Main Trunk Obstruction

Tomohisa Hirano; Kunihiko Tsuchiya; Kazuhiko Nishigaki; Kenji Sou; Tomoki Kubota; Shinsuke Ojio; Masanori Kawasaki; Shinya Minatoguchi; Hisayoshi Fujiwara; Katsumi Ueno; Hiroaki Hosokawa; Norihiko Morita; Toshihiko Nagano; Takahiko Suzuki; Sachirou Watanabe

doi:10.1253/circj.70.525

Clinical Investigation

Clinical Features of Emergency Electrocardiography in Patients With Acute Myocardial Infarction Caused by Left Main Trunk Obstruction

Tomohisa Hirano, Kunihiko Tsuchiya, Kazuhiko Nishigaki, Kenji Sou, Tomoki Kubota, Shinsuke Ojio, Masanori Kawasaki, Shinya Minatoguchi, Hisayoshi Fujiwara, Katsumi Ueno, Hiroaki Hosokawa, Norihiko Morita, Toshihiko Nagano, Takahiko Suzuki, Sachirou Watanabe

Author information

Tomohisa Hirano
Department of Regenerative and Cardiovascular Medicine, Gifu University Graduate School of Medicine
Kunihiko Tsuchiya
Department of Regenerative and Cardiovascular Medicine, Gifu University Graduate School of Medicine
Kazuhiko Nishigaki
Department of Regenerative and Cardiovascular Medicine, Gifu University Graduate School of Medicine
Kenji Sou
Department of Regenerative and Cardiovascular Medicine, Gifu University Graduate School of Medicine
Tomoki Kubota
Department of Regenerative and Cardiovascular Medicine, Gifu University Graduate School of Medicine
Shinsuke Ojio
Department of Regenerative and Cardiovascular Medicine, Gifu University Graduate School of Medicine
Masanori Kawasaki
Department of Regenerative and Cardiovascular Medicine, Gifu University Graduate School of Medicine
Shinya Minatoguchi
Department of Regenerative and Cardiovascular Medicine, Gifu University Graduate School of Medicine
Hisayoshi Fujiwara
Department of Regenerative and Cardiovascular Medicine, Gifu University Graduate School of Medicine
Katsumi Ueno
Gifu Municipal Hospital
Hiroaki Hosokawa
National Toyohashi Medical Center
Norihiko Morita
Matsunami General Hospital
Toshihiko Nagano
National Nagara Medical Center
Takahiko Suzuki
Toyohashi Heart Center
Sachirou Watanabe
Gifu Prefectural Hospital

Keywords: Electrocardiography, Left main trunk, Myocardial infarction

JOURNAL FREE ACCESS

2006 Volume 70 Issue 5 Pages 525-529

DOI https://doi.org/10.1253/circj.70.525

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Abstract

Background To diagnose left main trunk (LMT) infarction by 12-lead standard electrocardiogram (ECG) is an important emergency technique, but the features in LMT infarctions have not been clarified. Methods and Results The study enrolled 140 subjects who were divided into 4 groups according to the location of the culprit artery: 35 with LMT, 35 with left anterior descending artery (LAD), 35 with right coronary artery and 35 with left circumflex artery. Various parameters obtained from the ECGs were analyzed. Average QTc interval (0.51±0.06 s) in LMT group was markedly longer than that in the 3 other groups. Average QRS axis (-10±77 degrees) in LMT infarction showed a remarkable left deviation. ST-segment elevation in lead aV_R occurred in 28 patients (80.0%) in the LMT group. The ECG features of the LMT group could be classified into 2 main groups: right bundle branch block (RBBB) with a marked left axis deviation (RBBB + LADEV type) and ST-segment elevation in leads V_2-5, I and aV_L without abnormal axis deviation (LAD type). Conclusion Either ST-segment elevation in lead aV_R and marked prolongation of both the QRS width and QTc interval with a prominent abnormal axis deviation or ST-segment elevation in the broad anterior precordial lead with a normal QRS axis strongly suggests LMT infarction. (Circ J 2006; 70: 525 - 529)

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