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Coronary Artery Ligation and Intramyocardial Injection in a Murine Model of Infarction
Published on: June 7, 2011
The predictive value of aVR in determining the infarct related artery during primary percutaneous coronary
Ayman Gaballa1, Wala Farid2, Ahmad Al-Kersh2
1Department of Cardiology, Sabah Al-Ahmad Cardiac Center, Al-Amiri Hospital, Kuwait.
Insights
ST depression in lead aVR of 1 mm or more indicates the left circumflex artery as the culprit in inferior myocardial infarction, predicting a worse prognosis and larger infarct size.
Area of Science:
- Cardiology
- Medical Diagnostics
- Interventional Cardiology
Background:
- Timely identification of the infarct-related artery is crucial for primary percutaneous coronary intervention.
- Risk stratification in acute myocardial infarction aids in patient management and prognosis.
Purpose of the Study:
- To evaluate the predictive value of ST-T changes in lead aVR for identifying the culprit artery in inferior myocardial infarction.
- To assess the prognostic significance of ST depression in lead aVR for risk stratification.
Main Methods:
- Prospective analysis of 100 acute inferior wall myocardial infarction patients.
- Categorization into two groups based on culprit artery: Right Coronary Artery (RCA) vs. Left Circumflex Coronary Artery (LCX).
- Comparison of ECG changes, cardiac enzymes, echocardiography, angiography, and complications between groups, with a focus on ST depression (≥1 mm) in lead aVR.
Main Results:
- ST depression ≥1 mm in lead aVR predicted LCX culprit artery with 66% sensitivity and 84% specificity.
- Patients with ST depression in aVR had significantly higher cardiac enzyme levels (indicating larger infarct size) and lower ejection fraction.
- Increased mitral regurgitation was observed in patients with ST depression in aVR, but no significant difference in in-hospital complications.
Conclusions:
- ST depression >1 mm in lead aVR is a significant predictor of LCX involvement in inferior myocardial infarction.
- This ECG finding serves as a valuable tool for early risk stratification and predicting poorer outcomes.
Background:
Isolation of infract related artery and timely revascularisation remains vital in the setting of primary percutaneous coronary intervention.
Objectives:
To analyse the predictive value of ST-T changes in lead aVR in inferior myocardial infarction in terms of prognosis and timely risk stratification.
Methods:
We conducted a prospective analysis of acute inferior wall myocardial infarction patients. One hundred patients were categorised into two groups according to the culprit artery: group I, right coronary artery (RCA) and group II, left circumflex coronary artery (LCX), with 50 patients in each group. A comparative study was performed between the two groups, comprising the following data outputs: electrocardiogram (ECG) changes that could help determine the culprit artery, cardiac enzyme levels, echocardiographic findings, coronary angiography findings and in-hospital complications. The same patients were divided into two groups according to the presence or absence of 1 mm ST depression in lead aVR. A comparison analysis was performed between the two groups including: cardiac enzyme levels, echocardiographic findings, coronary angiography findings and in-hospital complications.
Results:
ST depression in aVR ≥ 1 mm predicted the LCX as a culprit artery with sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) recorded at 66%, 84%, 80.5% and 71.2%, respectively. Also, patients with ST depression in aVR ≥ 1 mm showed significantly higher cardiac enzyme levels, indicating larger infarct size, with mean peak creatinine kinase (CK) = 1560 (1057-2375) IU/L versus 970 (613-1683) IU/L, (P value = 0.014), lower ejection fraction (Ef) with mean Ef = 47.93 ± 8.04 versus 54.66 ± 6.52, (P value < 0.001) and more significant mitral regurgitation: 17 (41.5%) patients versus 11 (18.6%) patients (P value = 0.012). Regarding in-hospital complications, there were no significant differences.
Conclusions:
ST depression of >1 mm in lead aVR predicts LCX as the infarct related artery and is a predictor of poor outcome in patients with inferior myocardial infarction.
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