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Predictive Value of ST-Segment Elevation in Lead aVR for Left Main and/or Three-Vessel Disease in Non-ST-Segment

Naoki Misumida1, Akihiro Kobayashi1, John T Fox2

  • 1Department of Internal Medicine.

Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
|April 18, 2015
PubMed

Insights

ST-segment elevation in lead aVR independently predicts left main and/or three-vessel disease (LM/3VD) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). This ECG finding aids in identifying high-risk patients requiring urgent intervention.

Area of Science:

  • Cardiology
  • Electrocardiography
  • Acute Coronary Syndromes

Background:

  • ST-segment elevation in lead aVR is a known predictor of severe coronary artery disease.
  • Previous studies on its predictive value in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) yielded conflicting results.
  • ST-segment elevation in aVR often corresponds to ST-segment depression in other leads, indicating reciprocal changes.

Purpose of the Study:

  • To evaluate the independent predictive value of ST-segment elevation in lead aVR for left main and/or three-vessel disease (LM/3VD) in patients with non-ST-segment elevation myocardial infarction (NSTEMI).
  • To assess the association between ST-segment elevation in lead aVR and in-hospital outcomes such as revascularization.

Main Methods:

  • Retrospective analysis of 379 patients diagnosed with NSTEMI.
  • Electrocardiograms (ECGs) were analyzed for ST-segment elevation (≥0.05 mV) in lead aVR.
  • ECGs were also reviewed for ST-segment depression (≥0.05 mV) in more than two contiguous leads.

Main Results:

  • ST-segment elevation in lead aVR was present in 26% of patients and was associated with a higher prevalence of LM/3VD (39% vs. 18%; P < 0.001).
  • Patients with ST-segment elevation in aVR also had increased rates of in-hospital revascularization (73% vs. 60%; P = 0.02), including coronary artery bypass grafting (19% vs. 7%; P < 0.001).
  • Multivariate analysis confirmed ST-segment elevation in lead aVR (OR 2.05) and ST-segment depression in V1-V4 (OR 2.99) as independent predictors of LM/3VD.

Conclusions:

  • ST-segment elevation in lead aVR is an independent predictor of LM/3VD in patients presenting with NSTEMI.
  • This ECG finding can aid clinicians in risk stratification and timely management decisions for NSTEMI patients.
  • ST-segment depression in anterior precordial leads also emerged as a significant independent predictor of LM/3VD.
Abstract

Keywords:
acute coronary syndromecoronary artery bypass graftingelectrocardiographylead aVRnon-ST-segment elevation myocardial infarction

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