AMP EM - January 19, 2016 - By Chris Paul // Edited by Michael Barrie
Left Main Coronary Artery Disease
Here is the link to a good review of this topic, and Summarized below
“Given the ability of STE in aVR to predict critical coronary lesions and death, this ECG pattern is increasingly being recognised as a ‘STEMI equivalent’ that requires emergent reperfusion therapy to prevent cardiogenic shock and death.”
Furthermore, the presence or absence of STE in aVR may potentially inform the decision to give thienopyridine platelet inhibitors (e.g. clopidogrel, prasugrel) during an acute coronary syndrome:
- Clopidogrel treatment ≤ 7 days before CABG is associated with an increase in major bleeding, haemorrhage-related complications, and transfusion requirements.
- Prasugrel is associated with even more bleeding than clopidogrel.
- If urgent CABG (within 7 days) is likely, then there is an argument for omitting thienopyridines during the initial management of an acute coronary syndrome (or at least using clopidogrel instead of prasugrel).”
This constellation of findings can be easily missed especially on more subtle EKG’s with tachycardia where rate-related ST depressions may be seemingly explained away.”