Open AccessPredictive Value of ST‐Segment Elevation in Lead aVR for Left Main and/or Three‐Vessel Disease in Non–ST‐Segment Elevation Myocardial Infarction
Author(s) -
Misumida Naoki,
Kobayashi Akihiro,
Fox John T.,
Ha Sam,
Schweitzer Paul,
Kanei Yumiko
Publication year - 2016
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/anec.12272
Subject(s) - medicine , st segment , cardiology , myocardial infarction , st elevation , odds ratio , revascularization , confidence interval , coronary artery disease , elevation (ballistics) , acute coronary syndrome , electrocardiography , lead (geology) , st depression , geometry , mathematics , geomorphology , geology
Background ST‐segment elevation in lead aVR predicts left main and/or three‐vessel disease (LM/3VD) in patients with acute coronary syndromes. ST‐segment elevation in lead aVR is generally reciprocal to and accompanied by ST‐segment depression in precordial leads. Previous studies have assessed the independent predictive value of ST‐segment elevation in lead aVR for LM/3VD in non–ST‐segment elevation acute coronary syndrome and have reported conflicting results. Methods We performed a retrospective analysis of 379 patients with non–ST‐segment elevation myocardial infarction (NSTEMI). Electrocardiograms on presentation were reviewed especially for ST‐segment elevation ≥0.05 mV in lead aVR and ST‐segment depression ≥0.05 mV in more than two contiguous leads in any other leads. Results Among 379 patients, 97 (26%) patients had ST‐segment elevation in lead aVR and 88 (23%) patients had LM/3VD. Patients with ST‐segment elevation in lead aVR had a higher rate of LM/3VD (39% vs. 18%; P < 0.001) and in‐hospital revascularization (73% vs. 60%; P = 0.02) driven by a higher rate of in‐hospital coronary artery bypass grafting (19% vs. 7%; P < 0.001) than those without ST‐segment elevation in lead aVR. On multivariate analysis, ST‐segment elevation in lead aVR (odds ratio [OR] 2.05; 95% confidence interval [CI] 1.10–3.77; P = 0.02) and ST‐segment depression in leads V 1 –V 4 (OR 2.99; 95% CI 1.46–6.15; P = 0.003) were independent predictors of LM/3VD. Conclusion This study demonstrates that ST‐segment elevation in lead aVR is an independent predictor of LM/3VD in patients with NSTEMI.