ST-Segment Deviation in Lead aVR on Admission Is Not Associated With Left Ventricular Function at Predischarge in First Anterior Wall ST-Segment Elevation Acute Myocardial Infarction

• Published in: The American journal of cardiology 2011-09, Vol.108 (5), p.625-629
• Main Authors: Goto, Yukie, MD, Tamura, Akira, MD, Kotoku, Munenori, MD, Kadota, Junichi, MD, PhD
• Format: Article
• Language: English
• Subjects: Analysis of Variance; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Chi-Square Distribution; Collateral Circulation; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Coronary heart disease; Creatine Kinase - blood; Electrocardiography; Female; Heart; Heart attacks; Humans; Male; Medical imaging; Medical sciences; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - physiopathology; Myocarditis. Cardiomyopathies; Patient admissions; Predictive Value of Tests; Prognosis; Regression Analysis; Risk Factors; Sensitivity and Specificity; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - physiopathology; Ventriculography, First-Pass
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2011.04.007

Previous studies have shown that the analysis of ST-segment deviation in lead aVR on admission provides useful information on angiographic coronary anatomy and risk stratification in acute coronary syndromes. However, the association between ST-segment deviation in lead aVR on admission and left ventricular (LV) function has not been fully investigated in anterior wall acute ST-segment elevation myocardial infarction. In this study, 237 patients with first anterior wall acute ST-segment elevation myocardial infarction were examined. The patients were divided into the following 3 groups according to ST-segment deviation in lead aVR on admission: 85 with ST-segment elevation ≥0.5 mm (group A), 106 without ST-segment deviation (group B), and 46 with ST-segment depression ≥0.5 mm (group C). LV ejection fractions at predischarge were compared among the 3 groups. Among the 3 groups, there were significant differences in the prevalences of proximal left anterior descending coronary artery (LAD) occlusion (group A 75.3%, group B 56.6%, group C 45.7%, p = 0.002), long LAD (group A 27.1%, group B 31.1%, group C 56.5%, p = 0.002), and good collaterals to the LAD (group A 40.0%, group B 25.4%, group C 17.4%, p = 0.01). LV ejection fractions at predischarge did not differ among the 3 groups (group A 56.4 ± 12.5%, group B 56.9 ± 12.7%, group C 53.3 ± 12.2%, p = 0.26). On a multiple regression analysis, establishment of Thrombolysis In Myocardial Infarction grade 3 flow, proximal LAD occlusion, and long LAD were associated with the LV ejection fraction at predischarge. In conclusion, ST-segment deviation in lead aVR on admission is not associated with LV function at predischarge in first anterior wall acute ST-segment elevation myocardial infarction.