The present study was designed to analyse the effect of ST segment changes in aVR lead and the well-known risk factors in ST-segment elevated myocardial infarction (STEMI) patients.
Materials and Methods
A total of 250 patients who were admitted between 2009 and 2010 with STEMI and ≥1 mm ST-segment elevation in aVR lead were enrolled in the study. The patients were followed for life-threatening events like acute pulmonary oedema, atrial fibrillation, AV block, ventricular tachycardia, length of stay in hospital and death.
Results
Among the enrolled patients, 222 were discharged and 28 died. Pulmonary oedema and mortality rates were significantly higher in patients with ST-segment elevation in aVR lead (both p=0.001).
Conclusions
There is a correlation of ST-segment elevation in aVR lead with poor outcome in STEMI. Therefore aVR lead must be analysed as well as the other leads and well-known risk factors while it estimates the prognosis.
KohnM.A., KwanE., GuptaM., TabasJ.A.Prevalence of acute myocardial infarction and other serious diagnoses in patients presenting to an urban emergency department with chest pain. J Emerg Med2005; 29(4): 383–90.
2.
TimmisA.D.Early diagnosis of acute myocardial infarction. BMJ1990; 301(6758): 941–2.
3.
AlpertJ.S., ThygesenK., AntmanE., BassandJ.P.Myocardial infarction redefined-a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol2000; 36(3): 959–69.
4.
GorgelsA.P., VosM.A., MulleneersR., de ZwaanC., BarF.W., WellensH.J.Value of the electrocardiogram in diagnosing the number of severely narrowed coronary arteries in rest angina pectoris. Am J Cardiol1993; 72(14): 999–1003.
5.
GorgelsA.P., EngelenD.J., WellensH.J.Lead aVR, a mostly ignored but very valuable in clinical electrocardiography. J Am Coll Cardiol2001; 38(5): 1355–6.
6.
YamajiH., IwasakiK., KusachiS., MurakamiT., HiramiR., HamamotoH.Prediction of acute left main coronary artery obstruction by 12-lead electrocardiography. ST segment elevation in lead aVR with less ST segment elevation in lead V1(1). J Am Coll Cardiol2001; 38(5): 1348–54.
7.
WilliamsonK., MattuA., PlautzC.U., BinderA., BradyW.J.Electrocardiographic applications of lead aVR. Am J Emerg Med2006; 24(7): 864–74.
8.
PahlmU.S., PahlmO., WagnerG.S.The standard 11-lead ECG. Neglect of lead aVR in the classical limb lead display. J Electrocardiol1996; 29 Suppl: 270–4
9.
KühlJ.T., BergR.M.Utility of lead aVR for identifying the culprit lesion in acute myocardial infarction. Ann Noninvasive Electrocardiol2009; 14(3): 219–25.
10.
RostoffP., PiwowarskaW.ST segment elevation in lead aVR and coronary artery lesions in patients with acute coronary syndrome. Kardiol Pol2006; 64(1): 8–14.
11.
KosugeM., KimuraK., IshikawaT., EbinaT., HibiK., TsukaharaK.Combined prognostic utility of ST segment in lead aVR and troponin T on admission in non-ST segment elevation acute coronary syndromes. Am J Cardiol2006; 97(3): 334–9.
12.
BarrabesJ.A., FiguerasJ., MoureC., CortadellasJ., Soler-SolerJ.Prognostic value of lead aVR in patients with a first non-STsegment elevation acute myocardial infarction. Circulation2003; 108(7): 814–9.
13.
YanA.T., YanR.T., KennellyB.M., AndersonF.A.Jr, BudajA., Lopez-SendonJ.Relationship of ST elevation in lead aVR with angiographic findings and outcome in non-ST elevation acute coronary syndromes. Am Heart J2007; 154(1): 71–8.
14.
PresD., GasiorM., LekstonA., GierlotkaM., HawranekM., TajstraM.Relationship between low-density lipoprotein cholesterol level on admission and in-hospital mortality in patients with ST-segment elevation myocardial infarction, with or without diabetes, treated with percutaneous coronary intervention. Kardiol Pol2010; 68(9): 1005–12.
15.
WangT.Y., NewbyL.K., ChenA.Y., MulgundJ., RoeM.T., SonelA.F.Hypercholesterolemia paradox in relation to mortality in acute coronary syndrome. Clin Cardiol2009; 32(9): E22–8.
16.
GrangerC.B., GoldbergR.J., DabbousO., PieperK.S., EagleK.A., CannonC.P.Global Registry of Acute Coronary Events Investigators. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med2003; 163(19): 2345–53.
17.
KangW.Y., JeongM.H., AhnY.K., KimJ.H., ChaeS.C., KimY.J.Korea Acute Myocardial Infarction Registry Investigators. Obesity paradox in Korean patients undergoing primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. J Cardiol2010; 55(1): 84–91.
18.
KosugeM., KimuraK., IshikawaT., EndoT., HongoY., ShigemasaT.ST-segment depression in lead aVR predicts predischarge left ventricular dysfunction in patients with reperfused anterior acute myocardial infarction with anterolateral ST-segment elevation. Am Heart J2001; 142(1): 51–7.
19.
SzymanskiF.M., GrabowskiM., FilipiakK.J., KarpinskiG., OpolskiG.Admission ST-segment elevation in lead aVR as the factor improving complex risk stratification in acute coronary syndromes. Am J Emerg Med2008; 26(4): 408–12.
