Prognostic implications of ST-segment elevation in lead aVR in patients with acute coronary syndrome: A meta-analysis
Aqian Wang1, Vikas Singh2, Yichao Duan3
1Department of Cardiology, Gansu Provincial Hospital, Lanzhou, China.
Insights
ST-segment elevation in lead aVR (STE aVR) during acute coronary syndrome (ACS) indicates higher in-hospital mortality and adverse events. Greater STE aVR magnitude correlates with worse prognosis, highlighting its role as a critical prognostic marker.
Area of Science:
- Cardiology
- Clinical Medicine
- Diagnostic Tools
Background:
- ST-segment elevation (STE) in lead aVR is recognized for identifying left main or left anterior descending coronary artery obstruction in acute coronary syndrome (ACS).
- The prognostic significance of STE in lead aVR for patient outcomes has remained largely unestablished.
Purpose of the Study:
- To systematically evaluate the prognostic implication of STE in lead aVR on patient outcomes during ACS.
- To determine the association between STE in lead aVR and in-hospital mortality, reinfarction, heart failure, and 90-day mortality.
Main Methods:
- A systematic literature search was conducted across PubMed, EMBASE, Cochrane Library, and Web of Science.
- Included studies focused on STE in lead aVR in ACS patients, with primary outcome as in-hospital mortality and secondary outcomes including reinfarction, heart failure, and 90-day mortality.
Main Results:
- Seven studies involving 7,700 patients were analyzed.
- Patients with STE in lead aVR exhibited significantly higher in-hospital mortality (OR: 4.37) compared to those without.
- Higher STE magnitude (>0.1 mV) was associated with increased in-hospital mortality (OR: 2.00), and STE in aVR was linked to higher rates of reinfarction, heart failure, and 90-day mortality.
Conclusions:
- STE in lead aVR serves as a significant poor prognostic marker in ACS patients, associated with increased in-hospital mortality, reinfarction, heart failure, and 90-day mortality.
- The magnitude of STE in lead aVR is directly correlated with prognosis.
- Further research is warranted to confirm the independent predictive value of STE in aVR for adverse cardiovascular outcomes.
Background:
ST-segment elevation (STE) in lead aVR is a useful tool in recognizing patients with left main or left anterior descending coronary obstruction during acute coronary syndrome (ACS). The prognostic implication of STE in lead aVR on outcomes has not been established.
Methods:
We performed a systematic search for clinical studies about STE in lead aVR in four databases including PubMed, EMBASE, Cochrane Library, and Web of Science. Primary outcome was in-hospital mortality. Secondary outcomes included in-hospital (re)infarction, in-hospital heart failure, and 90-day mortality.
Results:
We included 7 studies with a total of 7,700 patients. The all-cause in-hospital mortality of patients with STE in lead aVR during ACS was significantly higher than that of patients without STE (OR: 4.37, 95% CI 1.63 to 11.68, p = .003). Patients with greater STE (>0.1 mV) in lead aVR had a higher in-hospital mortality when compared to lower STE (0.05-0.1 mV) (OR: 2.00, 95% CI 1.11-3.60, p = .02), However, STE in aVR was not independently associated with in-hospital mortality in ACS patients (OR: 2.72, 95% CI 0.85-8.63, p = .09). The incidence of in-hospital myocardial (re)infarction (OR: 2.77, 95% CI 1.30-5.94, p = .009), in-hospital heart failure (OR: 2.62, 95% CI 1.06-6.50, p = .04), and 90-day mortality (OR: 10.19, 95% CI 5.27-19.71, p < .00001) was also noted to be higher in patients STE in lead aVR.
Conclusions:
This contemporary meta-analysis shows STE in lead aVR is a poor prognostic marker in patients with ACS with higher in-hospital mortality, reinfarction, heart failure and 90-day mortality. Greater magnitude of STE portends worse prognosis. Further studies are needed to establish an independent predictive role of STE in aVR for these adverse outcomes.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT