ST-segment elevation in lead aVR in the setting of acute coronary syndrome

The purpose of our study was to assess the value of aVR ST-segment elevation (STE) during acute non ST-segment elevation myocardial infarction (NSTEMI) or unstable angina.

STE in lead aVR has been associated with severe coronary lesions in patients with acute coronary syndromes. However, there are conflicting data regarding the prognostic significance of this finding.

We evaluated the initial electrocardiogram (ECG) in 129 patients admitted to our hospital with acute NSTEMI or unstable angina without STE in leads other than aVR or V1. STE in aVR lead was measured and echocardiography and coronary angiography were performed within 48-72 hours after hospitalization.

Overall, 40.3% (52 patients) had more than 0.05 mv STE in lead aVR. These patients had an increased prevalence of ST ≥ 1 mm in lead V1, a more frequent and extensive ST-segment depression (STD) in other leads, a higher prevalence of anterior and lateral STD and a lower frequency of isolated negative T waves. It was also strongly associated with cardiac enzyme rising and a trend toward higher 3-month mortality. Furthermore, patients with STE in lead aVR were more likely to have three-vessel or multivessel disease, higher Gensini score of the coronary arteries, lower left ventricular ejection fraction (LVEF) and higher incidence of mitral regurgitation (MR).

Our study showed that among ECG markers, the sole criterion STE in lead aVR was independently associated with atherosclerosis severity and decreased LVEF. Also, it was significantly associated with the presence of MR.