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Acute ST-segment elevation myocardial infarction: The prognostic importance of lead augmented vector right and leads
Veeresh Patil Hebbal1, Huliyurdurga Srinivasasetty Natraj Setty1, Cholenahalli Manjunath Sathvik1
1Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
Insights
Electrocardiogram (ECG) leads aVR, V7, V8, and V9 can help predict outcomes in ST-elevation myocardial infarction (STEMI) patients. ST deviation in lead aVR, particularly depression, indicates higher mortality risk in STEMI.
Area of Science:
- Cardiology
- Medical Diagnostics
- Clinical Research
Background:
- Acute myocardial infarction (MI) presents significant mortality and morbidity risks.
- Electrocardiograms (ECG) are crucial for diagnosing MI, identifying culprit vessels, and prognostication.
- The prognostic value of specific ECG leads like augmented vector right (aVR) and V7-V9 in acute MI is often underutilized.
Purpose of the Study:
- To investigate the clinical utility of lead aVR and leads V7-V9 in predicting outcomes for patients with ST-elevation myocardial infarction (STEMI).
- To analyze the correlation between ST deviations in these leads and patient mortality.
- To assess the role of these leads in differentiating anterior wall MI (AWMI) and inferior wall MI.
Main Methods:
- A cohort of 209 STEMI patients underwent comprehensive ECG (including V7-9) and 2D-ECHO.
- Patients received revascularization via primary percutaneous coronary intervention.
- The study analyzed ST deviations in leads aVR, V7, and V8-9 in relation to MI location and patient outcomes over a 1-month follow-up.
Main Results:
- The study population (85.1% male, 35.8% diabetic, 60.2% smokers) predominantly had AWMI (55.5%).
- ST deviation in lead aVR was observed in 75.1% of patients (17.7% elevation, 47.1% depression).
- ST elevation in V7 occurred in 27.6%, and in V8-9 in 7.5%. Crucially, all 11.9% of deaths exhibited lead aVR ST segment deviation (P < 0.001).
Conclusions:
- ST deviation in lead aVR and V7 can identify high-risk STEMI patients.
- Lead aVR ST depression is associated with higher mortality than ST elevation, suggesting more extensive myocardial involvement.
- These underutilized ECG leads offer valuable prognostic information for STEMI management.
Background:
Acute myocardial infarction (MI) is associated with high mortality and among survivors have high morbidity. Electrocardiogram (ECG), a cost-effective and easily available, has traditionally been used not only just for diagnosis of MI but also for culprit vessel recognition and for prognostication. However, the role of lead augmented vector right (aVR) and leads V7-V9 in acute MI are often neglected in clinical practice. We studied the role of lead aVR and leads V7-V9 in ST-elevation MI (STEMI) patients.
Methods:
A total of 209 patients presenting with STEMI were enrolled in the study. History of comorbid conditions and habits was enquired. Routine blood tests were performed. Full spectrum ECG (including V7-9) and 2D-ECHO was performed on all patients. All the patients underwent revascularization by primary percutaneous coronary intervention. The role of lead aVR, lead V7, and leads V8-9 was analyzed in anterior wall MI (AWMI) and inferior wall MI. All the patients were followed up for 1 month for outcome assessment.
Results:
Of the 209 patients, 85.1% were males and 35.8% were diabetic, 60.2% were smokers, AWMI accounted for 55.5%. Lead aVR ST deviation was noted in 75.1% of patients (elevation in 17.7% and depression in 47.1%). V7 ST elevation occurred in 27.6% and V8-9 elevation occurred in 7.5% of the study population. Total death was 11.9% in the study (including the in-hospital mortality), all these patients had lead aVR ST segment deviation (P < 0.001).
Conclusion:
Lead aVR ST deviation and Lead V7 ST deviation helps to prognosticate the STEMI patients as high risk and those with aVR ST depression had higher mortality compared to aVR ST elevation because of larger myocardial involvement.
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