学术急诊医学档案

卷 5 编号 1 (2017)

The Relationship of ST Segment Changes in Lead aVR with Outcomes after Myocardial Infarction; a Cross Sectional Study

学术急诊医学档案, 卷 5 编号 1 (2017), 1 一月 2017 , 第 e73 页
https://doi.org/10.22037/aaem.v5i1.198

摘要

Introduction: Among the 12 leads studied in electrocardiography (ECG), lead aVR can be considered as the most forgotten part of it since no attention is paid to it as the mirror image of other leads. Therefore, the present study has been designed with the aim of evaluating the prevalence of ST segment changes in lead aVR and its relationship with the outcome of these patients.

Methods: In this retrospective cross sectional study medical profiles of patients who had presented to emergency department with the final diagnosis of myocardial infarction (MI) in a 4-year period were evaluated regarding changes of ST segment in lead aVR and its relationship with in-hospital mortality, the number of vessels involved, infarct location and cardiac ejection fraction.

Results: 288 patients with the mean age of 59.00 ± 13.14 (18 – 91) were evaluated (79.2% male). 168 (58.3%) patients had the mentioned changes (79.2% male). There was no significant relationship between presence of ST changes in lead aVR with infarct location (p = 0.976), number of vessels involved (p = 0.269) and ejection fraction on admission (p = 0.801). However, ST elevation ≥ 1 mv in lead aVR had a significant relationship with mortality (Odds = 7.72, 95% CI: 3.07 – 19.42, p < 0.001). Sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios of ST elevation ≥ 1 for prediction of in-hospital mortality were 41.66 (95% CI: 22.79 – 63.05), 91.53 (95% CI: 87.29 – 94.50), 31.25 (95% CI: 16.74 – 50.13), 94.44 (95% CI: 90.65 – 96.81), 0.45 (95% CI: 0.25 – 0.79), and 0.05 (95% CI: 0.03 – 0.09), respectively.

Conclusion: Based on the results of the present study, the prevalence of ST segment changes in lead aVR was estimated to be 58.3%. There was no significant relationship between these changes and the number of vessels involved in angiography, infarct location and cardiac ejection fraction. However, presence of ST elevation ≥ 1 in lead aVR was associated with 8 times increase in in-hospital mortality risk.

关键词:
  • Myocardial infarction
  • electrocardiography
  • patient outcome assessment
  • st elevation myocardial infarction

参考

Reddy KS. Cardiovascular disease in non-Western countries. N Engl J Med. 2004;350(24):2438-40.

Okrainec K, Banerjee DK, Eisenberg MJ. Coronary artery disease in the developing world. Am Heart J. 2004;148(1):7-15.

Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, et al. The TIMI risk score for unstable angina/non–ST elevation MI: a method for prognostication and therapeutic decision making. Jama. 2000;284(7):835-42.

James SK, Lindahl B, Siegbahn A, Stridsberg M, Venge P, Armstrong P, et al. N-terminal pro–brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease. Circulation. 2003;108(3):275-81.

de Lemos JA, Morrow DA, Bentley JH, Omland T, Sabatine MS, McCabe CH, et al. The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes. New England Journal of Medicine. 2001;345(14):1014-21.

Haaf P, Reichlin T, Corson N, Twerenbold R, Reiter M, Steuer S, et al. B-type natriuretic peptide in the early diagnosis and risk stratification of acute chest pain. The American journal of medicine. 2011;124(5):444-52.

Alherbish A, Westerhout CM, Fu Y, White HD, Granger CB, Wagner G, et al. The forgotten lead: Does aVR ST-deviation add insight into the outcomes of ST-elevation myocardial infarction patients? Am Heart J. 2013;166(2):333-9.

Vikas Mishra M, Ramesh Thakur D, Jha MJ, Amit Goel M, Ashutosh Kumar M, Chandra Mohan Varma D, et al. Prediction of St deviations in lead avr as a noninvasive tool to predict the infarct-related coronary artery in patients with acute inferior-wall Myocardial infarction (the PreSt-riMi Study).

Ji ZG. TCTAP A-006 Clinical Significance of ST-Segment Changes in Lead aVR for Patients with Acute Coronary Syndrome. J Am Coll Cardiol. 2015;65(17):S3.

Kukla P, Bryniarski L, Dudek D, Królikowski T, Kawecka K. Prognostic significance of ST segment changes in lead aVR in patients with acute inferior myocardial infarction with ST segment elevation. Kardiologia Polska (Polish Heart Journal). 2012;70(2):111-8.

Senaratne MP, Weerasinghe C, Smith G, Mooney D. Clinical utility of ST-segment depression in lead AVR in acute myocardial infarction. J Electrocardiol. 2003;36(1):11-6.

Barrabés JA, Figueras J, Moure C, Cortadellas J, Soler-Soler J. Prognostic value of lead aVR in patients with a first non–ST-segment elevation acute myocardial infarction. Circulation. 2003;108(7):814-9.

Mahmoud KS, Al Rahman TMA, Taha H, Mostafa S. Significance of ST-segment deviation in lead aVR for prediction of culprit artery and infarct size in acute inferior wall ST-elevation myocardial infarction. The Egyptian Heart Journal. 2015;67(2):145-9.

Kosuge M, Kimura K, Ishikawa T, Ebina T, Hibi K, Toda N, et al. ST-segment depression in lead aVR: a useful predictor of impaired myocardial reperfusion in patients with inferior acute myocardial infarction. CHEST Journal. 2005;128(2):780-6.

Gorgels AP, Engelen D, Wellens HJ. Lead aVR, a mostly ignored but very valuable lead in clinical electrocardiography. Journal of the American College of Cardiology; 2001.

Yamaji H, Iwasaki K, Kusachi S, Murakami T, Hirami R, Hamamoto H, et al. Prediction of acute left main coronary artery obstruction by 12-lead electrocardiography: ST segment elevation in lead aVR with less ST segment elevation in lead V1. J Am Coll Cardiol. 2001;38(5):1348-54.

Wong C-K, Gao W, Stewart RA, French JK, Aylward PE, White HD. The prognostic meaning of the full spectrum of aVR ST-segment changes in acute myocardial infarction. Eur Heart J. 2012;33(3):384-92.

Tamura A. Significance of lead aVR in acute coronary syndrome. World J Cardiol. 2014;6(7):630.

Sorita A, Ahmed A, Starr SR, Thompson KM, Reed DA, Prokop L, et al. Off-hour presentation and outcomes in patients with acute myocardial infarction: systematic review and meta-analysis. BMJ. 2014;348:f7393.

  • 摘要 ##plugins.themes.ojsPlusA.frontend.article.viewed##: 422 ##plugins.themes.ojsPlusA.frontend.article.times##
  • PDF (English) ##plugins.themes.ojsPlusA.frontend.article.downloaded##: 193 ##plugins.themes.ojsPlusA.frontend.article.times##
  • HTML (English) ##plugins.themes.ojsPlusA.frontend.article.downloaded##: 48 ##plugins.themes.ojsPlusA.frontend.article.times##

##plugins.themes.ojsPlusA.frontend.article.downloadstatastics##

##plugins.block.makeSubmission.linkLabel##

##plugins.block.makeSubmission.linkLabel##

SJR

SCImago Journal & Country Rank

COPE

最新一期

消息