The prognostic significance of early and late right precordial lead (V 4 R) ST ‐segment elevation in patients with acute anterior myocardial infarction

Background The predictive significance of ST ‐segment elevation ( STE ) in lead V 4 R in patients with anterior ST ‐segment elevation myocardial infarction ( STEMI ) has not been well‐understood. In this study, we evaluated the prognostic value of early and late STE in lead V 4 R in patients with anterior STEMI . Methods A total 451 patients with anterior STEMI who treated with primary percutaneous coronary intervention ( PPCI ) were prospectively enrolled in this study. All patients were classified according to presence of STE (>1 mm) in lead V 4 R at admission and/or 60 min after PPCI . Based on this classification, all patients were divided into three subgroups as no V 4 R STE (Group 1), early but not late V 4 R STE (Group 2) and late V 4 R STE (Group 3). Results In‐hospital mortality had higher rates at group 2 and 3 and that had 2.1 and 4.1‐times higher mortality than group 1. Late V 4 R STE remained as an independent risk factor for cardiogenic shock (odds ratio [ OR ] 2.6; 95% confidence interval [ CI ] 1.9–4.3; p  < .001) and in‐hospital mortality ( OR 2.3; 95% CI 1.8–4.1; p  < .001). The 12‐month overall survival for group 1, 2, and 3 were 91.1%, 82.4%, and 71.4% respectively. However, the long‐term mortality also had the higher rate at group 3; late V 4 R STE did not remain as an independent risk factor for long‐term mortality ( OR 1.5; 95% CI 0.8–4.1; p : .159). Conclusion Late V 4 R STE in patients with anterior STEMI is strongly associated with poor prognosis. The record of late V 4 R in patients with anterior STEMI has an important prognostic value.