Prediction of significant left main coronary artery stenosis by the 12-lead electrocardiogram in patients with rest angina pectoris and the withholding of clopidogrel therapy

We report the prospective use of an electrocardiographic sign—lead aVR ST-segment elevation greater than that seen in lead V1—in patients with an acute coronary syndrome as a method to prompt early angiography, to withhold clopidogrel therapy, and to perform urgent coronary bypass surgery leading to successful clinical outcomes.