Related Experiment Video

Updated: Jan 27, 2026

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

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The value of ST-segment deviation in lead aVR for predicting the infarct-related artery in acute inferior STEMI: A

Yang-Yu Li1, Fang Zeng1, Ju Deng1

  • 1Department of Cardiology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China.

Journal of Electrocardiology
|January 25, 2026
PubMed

Insights

In inferior ST-segment elevation myocardial infarction (STEMI), aVR ST-segment depression (aVR-STD) effectively predicts the left circumflex artery (LCX) as the infarct-related artery (IRA). However, aVR ST-segment elevation (aVR-STE) has limited predictive value for the right coronary artery (RCA).

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Medical Electrocardiology

Background:

  • Identifying the infarct-related artery (IRA) is crucial in acute inferior ST-segment elevation myocardial infarction (STEMI).
  • The left circumflex artery (LCX) and right coronary artery (RCA) are the most common IRAs in inferior STEMI.
  • Electrocardiographic lead aVR ST-segment deviation shows potential for IRA prediction, but evidence is limited.

Purpose of the Study:

  • To systematically evaluate the diagnostic accuracy of lead aVR ST-segment deviation for predicting the IRA in inferior STEMI.
  • To differentiate between LCX and RCA as the IRA using aVR ST-segment changes.

Main Methods:

  • A meta-analysis was conducted using studies from Web of Science, PubMed, and Scopus up to March 2025.
  • Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated.
  • A bivariate effects model was employed for pooled analysis.

Main Results:

  • Twenty-four studies with 6416 participants were included.
  • aVR ST-segment depression (aVR-STD) showed good accuracy for predicting LCX IRA (AUC = 0.80).
  • aVR ST-segment elevation (aVR-STE) had limited predictive value for both LCX and RCA (AUC = 0.55 and 0.75, respectively).
  • aVR-STD also had poor predictive value for RCA (AUC = 0.23).

Conclusions:

  • aVR ST-segment depression (aVR-STD) is valuable for predicting LCX as the IRA in inferior STEMI.
  • The accuracy of aVR-STD may be influenced by the ST-segment reference point and smoking history.
  • aVR ST-segment elevation (aVR-STE) has limited utility in predicting the RCA as the IRA.
Abstract

Keywords:
Diagnostic accuracyInfarct-related arteryInferior STEMILead aVRMeta-analysis

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