Admission ST-segment elevation in lead aVR as the factor improving complex risk stratification in acute coronary syndromes

• Published in: The American journal of emergency medicine 2008-05, Vol.26 (4), p.408-412
• Main Authors: Szymański, Filip M., MD, Grabowski, Marcin, MD, PhD, Filipiak, Krzysztof J., MD, PhD, Karpiński, Grzegorz, MD, Opolski, Grzegorz, MD, PhD
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - epidemiology; Acute coronary syndromes; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Angina pectoris; Biological and medical sciences; Blood pressure; Cardiology. Vascular system; Cardiovascular disease; Coronary heart disease; Coronary vessels; Electrocardiography; Emergency; Emergency medical care; Female; Health risks; Heart; Heart attacks; Heart rate; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Mortality; Multivariate analysis; Myocardial infarction; Prognosis; Risk Assessment; Risk factors
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2007.06.015

Abstract This study aimed to analyze the prognostic value of the presence of ST elevation in lead aVR [aVR(+) ] in initial standard electrocardiogram (ECG) performed on admission in combination with clinical variables and Thrombolysis in Myocardial Infarction (TIMI) risk score for unstable angina/non–ST-elevation myocardial infarction (UA/NSTEMI). In 205 consecutive patients with UA/NSTEMI, we retrospectively evaluated admission ECG for aVR(+) of more than 0.5 mm. With the use of multivariate analysis, admission aVR(+) was found to be a strong and independent predictor of 30-day mortality. Mortality also increased with the severity of aVR(+) : 2.2%, 10.8%, 13.8%, 22.2%, 50% ( P value for trend