Predictive value of ST-segment deviation in aVR in patients suffering from acute coronary syndrome: A retrospective
Ji-Ge Hong1, Zhi-Yu Zeng1,2,3
1Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Insights
ST-segment elevation (STE) in aVR predicts left main/3-vessel disease in acute coronary syndrome (ACS) patients. Both STE and ST-segment depression (STD) in aVR independently predict major adverse cardiovascular events (MACE).
Area of Science:
- Cardiology
- Electrocardiography
- Acute Coronary Syndromes
Background:
- ST-segment changes in lead aVR are recognized predictors of left main and/or 3-vessel disease (LM/3-VD) in acute coronary syndrome (ACS).
- The prognostic implications of these electrocardiogram (ECG) findings, particularly concerning major adverse cardiovascular events (MACE), remain less explored.
Purpose of the Study:
- To investigate the association between ST-segment elevation (STE) or ST-segment depression (STD) in lead aVR and the morbidity of LM/3-VD in ACS patients.
- To evaluate the prognostic value of aVR ST-segment deviations for MACE and GRACE risk scores in ACS.
Main Methods:
- Retrospective analysis of 274 ACS patients categorized into ST-segment elevation (STE ≥ 0.05 mV), ST-segment depression (STD ≥ 0.05 mV), and isoelectric groups in aVR.
- Comparison of clinical characteristics, coronary angiography, MACE, and GRACE risk scores across groups.
- Multivariate analysis to identify independent predictors of LM/3-VD and MACE.
Main Results:
- Patients with STE or STD in aVR were older, had lower LVEF, more MACE, and higher GRACE scores than the isoelectric group.
- STE (≥ 0.05 mV) in aVR was the sole independent predictor of LM/3-VD, while STD was not.
- Both STE and STD (≥ 0.05 mV) in aVR independently predicted MACE.
- Increasing amplitude of STE in aVR correlated with increased MACE, GRACE score, and LM/3-VD incidence.
Conclusions:
- ST-segment elevation (STE) ≥ 0.05 mV in aVR is significantly associated with left main and/or 3-vessel disease in ACS patients.
- ST-segment deviation (STE or STD) ≥ 0.05 mV in aVR serves as an independent predictor of MACE and is linked to higher GRACE risk scores in ACS.
- ECG findings in aVR hold prognostic value for ACS patients, aiding in risk stratification.
Abstract:
Changes in the ST-segment in aVR of electrocardiogram have been used to predict the morbidity of left main and/or 3-vessel disease (LM/3-VD) in patients with acute coronary syndrome (ACS). However, the association with patient prognosis has rarely been reported. A total of 274 patients diagnosed with ACS were retrospectively evaluated following allocation into 1 of 3 groups: the ST-segment elevation (STE) group ≥ 0.05 mV, ST-segment depression (STD) group ≥ 0.05 mV, and the Isoelectric group in aVR. A comparison of clinical characteristics, coronary angiography results, major adverse cardiovascular events (MACE), and GRACE risk score was made. Patients in the STE and STD groups were older and had a lower LVEF, a greater number of MACE and higher GRACE risk score, compared with patients in the isoelectric group. Patients in the STE group had significantly greater morbidity due to LM/3-VD than did the non-STE groups. In addition, as the amplitude of STE in aVR increased, the number of MACE, GRACE risk score, and the incidence of LM/3-VD increased. Furthermore, after adjusting for other clinical factors, multivariate statistical results indicated that STE ≥ 0.05 mV in aVR was the only predictor of LM/3-VD, whereas STD ≥ 0.05 mV was not. It was found that STE or STD ≥ 0.05 mV in aVR was an independent predictor of MACE. STE ≥ 0.05 mV in aVR is associated with LM/3-VD. Furthermore, ST-segment deviation in aVR may have prognostic value of MACE and associated with higher GRACE risk scores in patients with ACS.
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