Early, accurate, non-invasive predictors of left main or 3-vessel disease in patients with non-ST-segment elevation acute coronary syndrome.

BACKGROUND In patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), identification of left main and/or 3-vessel disease (LM/3VD) is crucial for deciding whether to initiate early treatment with clopidogrel, which can increase the risk of surgical bleeding. METHODS AND RESULTS On admission, the clinical factors of 501 patients with NSTE-ACS, who underwent coronary angiography, were evaluated. ST-segment shifts and the widest QRS duration were measured on an admission 12-lead electrocardiogram. Ninety-six patients had LM/3VD. Univariate analysis indicated that many factors were related to LM/3VD. On multivariate analysis, QRS duration (odds ratio (OR) 9.04, P<0.01), the degree of ST-segment elevation in lead aVR (OR 7.10, P<0.01), and positive-troponin T (OR 1.52, P<0.05) were independent predictors of LM/3VD. A QRS duration of >90 ms and a ST-segment elevation in lead aVR of >or=0.5 mm best identified LM/3VD. A QRS duration of >90 ms, a ST-segment elevation in lead aVR of >or=0.5 mm, and a positive-troponin T identified LM/3VD with sensitivities of 88%, 76%, and 54% (P<0.01), and specificities of 88%, 86%, and 71% (P<0.01), respectively. CONCLUSIONS A prolonged QRS duration, ST-segment elevation in lead aVR, and a positive-troponin T on admission are useful predictors of LM/3VD in patients with NSTE-ACS. In particular, a maximal QRS duration of >90 ms was the most sensitive predictor of LM/3VD.