ST segment elevation in lead aVR and coronary artery lesions in patients with acute coronary syndrome
Paweł Rostoff1, Wiesława Piwowarska
1Klinika Choroby Wieńcowej, Instytut Kardiologii, Collegium Medicum UJ, ul. Pradnicka 80, 31-202 Kraków. sekr_kchw@szpitaljp2.krakow.pl
Insights
ST segment elevation in lead aVR during acute coronary syndrome (ACS) indicates severe coronary artery disease, particularly left main coronary artery disease (LMCAD). This ECG finding is a critical marker for identifying high-risk patients needing prompt intervention.
Area of Science:
- Cardiology
- Clinical Electrocardiography
- Acute Coronary Syndromes
Background:
- The prognostic significance of ST segment elevation in lead aVR for acute coronary syndrome (ACS) is increasingly recognized.
- Its association with severe coronary artery disease, including left main coronary artery stenosis (LMCAS) and three-vessel disease, warrants further investigation.
Purpose of the Study:
- To analyze the correlation between ST segment elevation in lead aVR and the angiographic severity of coronary artery disease in ACS patients.
- To identify independent predictors of ST segment elevation in aVR and severe coronary artery disease manifestations.
Main Methods:
- A cohort of 134 ACS patients were divided into two groups: 54 with ST elevation in aVR and 80 without.
- Coronary angiography was performed to assess disease severity.
- Logistic regression models were employed to determine factors associated with ST elevation in aVR, LMCAS, and three-vessel disease.
Main Results:
- Patients with ST elevation in aVR exhibited significantly higher prevalence of three-vessel disease (61.1% vs 35.0%) and LMCAS (55.6% vs 17.5%).
- Independent predictors for ST elevation in aVR included LMCAS (OR 6.1), ST elevation in V1 (OR 3.03), and diabetes (OR 2.89).
- LMCAS was predicted by three-vessel disease and ST elevation in aVR; three-vessel disease was predicted by LMCAS, diabetes, male gender, and prior myocardial infarction.
Conclusions:
- ST segment elevation in lead aVR is a valuable indicator of severe coronary artery disease in ACS patients.
- Left main coronary artery disease is independently associated with ST segment elevation in aVR.
- While indicative of severe disease, three-vessel disease and LMCAS equivalents are not independent predictors of ST segment elevation in aVR on standard ECGs in ACS.
Introduction:
Recently, the prognostic value of ST segment elevation in lead aVR in acute coronary syndrome (ACS) and its relationship with significant stenosis of the left main coronary artery (LMCAS) and three-vessel disease have been highlighted.
Aim:
Analysis of the relationship between ST segment elevation observed in aVR lead and angiographic severity of coronary artery disease in patients with ACS.
Methods:
The study involved 134 patients with ACS, including 54 subjects with ST elevation in aVR (group A) and 80 patients without elevation of ST in the same lead (group B), aged 33-78 years, mean 59.9+/-9.7 years. The severity of coronary artery disease was compared between the two groups. The logistic regression model was used for the analysis of factors affecting ST segment in aVR, as well as LMCAS and three-vessel disease probability.
Results:
In patients with ST elevation in aVR, three-vessel disease prevalence was two times higher (61.1% vs 35.0%; p <0.01), and LMCAS - three times higher (55.6% vs 17.5%; p <0.000001) than in those without ST elevation in aVR. Factors independently associated with ST elevation in aVR were LMCAS (OR 6.1; 95% CI 2.62-14.23; p <0.00005), ST segment elevation in V1 (OR 3.03; 95% CI 1.34-6.86; p <0.01) and diabetes (OR 2.89; 95% CI 1.17-7.15; p <0.05). The predictors of LMCAS were three-vessel disease and ST elevation in aVR, while the predictors of three-vessel disease were: LMCAS, diabetes, male gender and history of myocardial infarction.
Conclusions:
Elevation of the ST segment in aVR in the setting of acute coronary syndrome identifies patients with severe coronary artery disease. Only left main coronary artery disease, however, remains independently associated with ST segment elevation in aVR. Three-vessel disease and the left main coronary artery stenosis equivalent are not independent predictors of ST segment elevation in aVR of standard electrocardiograms recorded in patients with acute coronary syndrome.
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