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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

ST-segment elevation resolution in lead aVR: a strong predictor of adverse outcomes in patients with non-ST-segment

Masami Kosuge1, Toshiaki Ebina, Kiyoshi Hibi

  • 1The Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.

Circulation Journal : Official Journal of the Japanese Circulation Society
|June 26, 2008
PubMed

Insights

ST-segment elevation in lead aVR without resolution in non-ST-segment elevation acute coronary syndromes (NSTE-ACS) patients predicts adverse outcomes. This finding highlights aVR ST elevation resolution as a crucial prognostic indicator in NSTE-ACS.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Diagnostic Electrocardiography

Background:

  • The prognostic significance of ST-segment elevation resolution in lead aVR for patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) remains incompletely understood.
  • Lead aVR electrocardiogram (ECG) findings are increasingly recognized for their role in assessing acute coronary syndromes.

Purpose of the Study:

  • To investigate the impact of ST-segment elevation resolution in lead aVR on clinical outcomes in patients diagnosed with NSTE-ACS.
  • To determine if ST-segment elevation in lead aVR without subsequent resolution is an independent predictor of adverse events.

Main Methods:

  • Electrocardiograms (ECGs) were analyzed on admission and at 6 hours in 367 NSTE-ACS patients.
  • ST-segment elevation >or=0.5 mm in lead aVR was considered significant (ST upward arrowaVR).
  • ST resolution was defined as >50% reduction in ST elevation in lead aVR from admission to 6 hours.

Main Results:

  • 92 patients presented with ST upward arrowaVR; 50 achieved ST resolution.
  • ST upward arrowaVR without resolution was linked to older age, greater ST depression in other leads, elevated troponin T, and more extensive coronary artery disease (left main and/or 3-vessel).
  • Patients with ST upward arrowaVR without resolution had significantly higher rates of 30-day adverse events, including death, reinfarction, or urgent revascularization (HR 5.62, p=0.018).

Conclusions:

  • ST upward arrowaVR without ST resolution is a potent independent predictor of 30-day adverse outcomes in NSTE-ACS patients.
  • The absence of ST resolution in lead aVR correlates with the extent and severity of coronary artery disease.
  • Monitoring ST-segment resolution in lead aVR offers valuable prognostic information for NSTE-ACS management.
Abstract

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