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Faramrzzadeh R, Shahabi Raberi V. Prognostic Value of ST Segment Changes in aVR Lead in Patients with Non-STEMI or Anterolateral STEMI. sjmshm 2022; 4 (2) :1-5
URL: http://sjmshm.srpub.org/article-3-184-en.html
Assistant Professor, Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran
Abstract:   (359 Views)
Background: ST segment changes in aVR lead may effectively predict early mortality in patients with acute myocardial infarction (MI). We aimed to assess the value of ST segment changes in aVR lead to predict outcome in patients with anterolateral MI or with non-ST segment elevation MI (STEMI). Methods: The hospital recorded files of 200 consecutive patients with one of the two diagnoses of anterolateral MI or non-STEMI were retrospectively assessed. Four subgroups were defined as the group with ST elevation > 0.5 mV in aVR lead (n = 53), 2) ST depression > 0.5 mV in aVR lead (n = 34), 3) without ST change in aVR (n = 87), and 4) with any ST change in aVR (n = 26). Results: In-hospital mortality rate was 30.2% in the group with ST elevation, 23.5% in those with ST depression, 9.2% in those without ST change, and 11.5% in those with any ST change in aVR that was higher two former groups. The prevalence of repeated MI was 17%, 2.9%, 2.3%, and 3.8% respectively indicating higher in-hospital MI in the group suffered ST-segment elevation MI. The rate of revascularization and length of hospital stay did not also differ across the groups. In multivariate regression model, both ST elevation and ST depression in aVR predicted in-hospital death. Main predictor for in-hospital MI included the presence of as ST elevation in aVR lead. Conclusion: A significant change of ST segment in aVR lead predicts both in-hospital mortality and reccurrence of MI within hospitalization in patients with anterolateral MI or with non-STEMI.
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Type of Study: Research | Subject: Cardiology and Cardiovascular Medicine
Received: 2022/02/25 | Revised: 2022/04/11 | Accepted: 2022/04/18 | Published: 2022/04/25

References
1. Ryan TJ, Anderson JL, Antman EM, et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on management of acute myocardial infarction). Circ. 1996; 94: 2341-50. [DOI:10.1161/01.CIR.94.9.2341] [PMID]
2. Bertrand ME, Simoons ML, Fox KA. et al. Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation. Recommendations of the Task Force of the European Society of Cardiology. Eur Heart J. 2000; 21: 1406-1432. [DOI:10.1053/euhj.2000.2301] [PMID]
3. Arnold AER, Simoons ML. Expected infarct size without thrombolysis: a concept that predicts immediate and long-term benefit from thrombolysis for evolving myocardial infarction. Eur Heart J. 1997; 18: 1736-1748. [DOI:10.1093/oxfordjournals.eurheartj.a015168] [PMID]
4. Moshkovitz Y, Sclarovsky S, Behar S, et al. Infarct site-related mortality in patients with recurrent myocardial infarction. SPRINT Study Group. Am J Med. 1993; 94: 388-394. [DOI:10.1016/0002-9343(93)90149-J] [PMID]
5. Braunwald E, Antman EM, Beasley JW, Robert M, Melvin D, Judith S, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST segment elevation myocardial infarction: a report of the American College of Cardiology/American Heart AssociationTask Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). Circ. 2002; 106: 1893-1900. [DOI:10.1161/01.CIR.0000037106.76139.53] [PMID]
6. Lee HS, Cross SJ, Rawles JM, Jennings KP. Patients with suspected myocardial infarction who present with ST depression. Lancet, 1993; 342: 1707-1714. [DOI:10.1016/0140-6736(93)92186-W] [PMID]
7. Cannon CP, McCabe CH, Stone PH, Rogers WJ, Schactman M, Thompson BW, et al. The electrocardiogram predicts one-year outcome of patients with unstable angina and non-Q wave myocardial infarction: results of the TIMI III Registry ECG Ancillary Study. J Am Coll Cardiol. 1997; 33: 133-140.
8. Haim M, Benderley M, Hod H, Reicher-Reiss H, Goldbourt U, Behar S. The outcome of patients with a first non-Q wave acute myocardial infarction presenting with ST segment depression, ST segment elevation, or no ST deviations on the admission electrocardiogram. Int J Cardiol. 1998; 67: 39-46. [DOI:10.1016/S0167-5273(98)00243-5] [PMID]
9. Diderholm E, Andrén B, Frostfeldt G, Genberg M, Jernberg T, Lagerqvist B, et al. ST depression at entry indicates severe coronary lesions and large benefits of an early invasive treatment strategy in unstable coronary artery disease: the FRISC II ECG substudy. Eur Heart J. 2002; 23: 41-49. [DOI:10.1053/euhj.2001.2694] [PMID]
10. Solomon DH, Stone PH, Glynn RJ, Ganz DA, Gibson CM, Tracy R, et al. Use of risk stratification to identify patients with unstable angina likeliest to benefit from an invasive versus conservative management strategy. J Am Coll Cardiol. 2001; 38: 969-976. [DOI:10.1016/S0735-1097(01)01503-0] [PMID]
11. Pahlm US, Pahlm O, Wagner GS. The standard 11-lead ECG: neglect of lead aVR in the classical limb lead display. J Electrocardiol. 1996; 29(suppl): 270-27. [DOI:10.1016/S0022-0736(96)80074-4] [PMID]
12. Khademvatani K, Basiri M, Alinejad V, Seyed Mohammad Zad MH. Prevalence and correlates of aortic root dilatation in patients with essential hypertension admitted to Seyedoshohada Hospital, Urmia 2012-2013. J Glob Pharma Tech. 2016; 02(8): 01-06.
13. Seyed Mohammad Zad MH, Khalili N, Alinejad V, Khadem Vatani K. Is there a correlation between coronary artery ectasia and neutrophil-lymphocyte ratio? J Glob Pharma Tech. 2016; 02(8): 01-06.
14. Khademvatan K, Alinejad V, Eghtedar S, Rahbar N, Agakhani N. Survey of the relationship between metabolic syndrome and myocardial infarction in hospitals of Urmia University of medical sciences. Glob J Health Sci. 2014 Sep 18; 6(7 Spec No): 58-65. doi: 10.5539/gjhs.v6n7p58 [DOI:10.5539/gjhs.v6n7p58] [PMID] []
15. Haghjoo M, Hajahmadi M, Fazelifar AF, Sadr-Amel MA. Efficacy and safety of different antitachycardia pacing sites in the termination of ventricular tachycardia in patients with biventricular implantable cardioverter-defibrillator. Europace, 2011 April; 13(4): 509-513. [DOI:10.1093/europace/euq513] [PMID]
16. Heris SO, Rahimi B, Faridaalaee G, Hajahmadi M, Sayyadi H, Naghipour B. QT dispersion after thrombolytic therapy. Int Cardiovasc Res J. 2014 December; 8(4): 161-165.
17. Rahimi Darabad B, Vatandust J, Pourmousavi Khoshknab MM, Hajahmadi Poorrafsanjani M. Survey of the effect of opioid abuse on the extent of coronary artery diseases. Glob J Health Sci. 2014; 6(7): 83-91. [DOI:10.5539/gjhs.v6n7p83] [PMID] []
18. Hajahmadi Poorrafsanjani M, Rahimi Darabad B. Evaluate the sensitivity and specificity echocardiography in trans-Doppler and tissue Doppler method in the estimation of left ventricular end-diastolic pressure. Glob J Health Sci. 2014; 6(7): 92-97. [DOI:10.5539/gjhs.v6n7p92] []
19. Wong CK, Gao W, Stewart RA, French JK, Aylward PE, Benatar J, White HD. Hirulog and early reperfusion or occlusion-2 investigators. Prognostic value of lead V1 ST elevation during acute inferior myocardial infarction. Circ. 2010 Aug 3; 122(5): 463-469. [DOI:10.1161/CIRCULATIONAHA.109.924068] [PMID]
20. Kukla P, Bryniarski L, Dudek D, Królikowski T, Kawecka Jaszcz K. Prognostic significance of ST segment changes in lead aVR in patients with acute inferior myocardial infarction with ST segment elevation. Kardiol Pol. 2012; 70(2): 111-118.
21. Alherbish A, Westerhout CM, Fu Y, White HD, Granger CB, Wagner G, Armstrong PW. The forgotten lead: does aVR ST-deviation add insight into the outcomes of ST-elevation myocardial infarction patients? Am Heart J. 2013 Aug; 166(2): 333-339. doi: 10.1016/j.ahj.2013.05.018 [DOI:10.1016/j.ahj.2013.05.018] [PMID]
22. 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. Circ. 2003 Aug 19; 108(7): 814-819. [DOI:10.1161/01.CIR.0000084553.92734.83] [PMID]
23. Raymond T Yan, Andrew T Yan, Kenneth W Mahaffey, Harvey D White, Karen Pieper, Jie-Lena Su, Carl J. Prognostic utility of quantifying evolutionary ST-segment depression on early follow-up electrocardiogram in patients with non ST-segment elevation acute coronary syndromes. Eur Heart J. 2010; 31: 958-966. [DOI:10.1093/eurheartj/ehp548] [PMID]
24. Taglieri N, Marzocchi A, Saia F, Marrozzini C, Palmerini T, Ortolani P, et al. Short- and long-term prognostic significance of ST-segment elevation in lead aVR in patients with non-ST-segment elevation acute coronary syndrome. Am J Cardiol. 2011 Jul 1; 108(1): 21-28. [DOI:10.1016/j.amjcard.2011.02.341] [PMID]

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