Electrocardiographic Findings of Severe Left Main Coronary Artery Stenosis

Studies have documented the occurrence of ST elevation in lead aVR and/or diffuse ST depression in the setting of acute coronary syndromes (ACS) in patients with left main coronary stenosis (LMCS). We sought to describe the baseline ECG characteristics in LMCS patients outside of the ACS setting. Seventeen patients with >= 90% LMCS and 129 patients with 70-89% LMCS met criteria for the study. None of the 17 patients in the >= 90% LMCS group and 2/129 patients in the 70-89% LMCS group had ST elevation in aVR. None of the 17 patients in the > 90% LMCS group and 3/129 patients in the 70-89% LMCS group had ST depression in >= 6 leads. Twenty-four percent of patents in the > 90% LMCS group and 29% of patients in the 70-89% LMCS group had normal ECGs. While patients with severe LMCS outside of the ACS setting did not demonstrate ischemia, many exhibited normal ECGs.