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Prognostic value of lead aVR in patients with a first non-ST-segment elevation acute myocardial infarction.
Circulation. 2003 Aug 19; 108(7):814-9.Circ

Abstract

BACKGROUND

ST-segment elevation in lead aVR has been associated with severe coronary artery lesions in patients with acute coronary syndromes, but the prognostic significance of this finding is unknown.

METHODS AND RESULTS

We analyzed the initial ECG in 775 consecutive patients admitted to our center with a first acute myocardial infarction without ST-segment elevation in leads other than aVR or V1. The rates of in-hospital death in patients without (n=525) and with 0.05 to 0.1 mV (n=116) or > or =0.1 mV (n=134) of ST-segment elevation in lead aVR were 1.3%, 8.6%, and 19.4%, respectively (P<0.001). After adjustment for the baseline clinical predictors and for ST-segment depression on admission, the odds ratios for death in the last 2 groups were, respectively, 4.2 (95% CI, 1.5 to 12.2) and 6.6 (95% CI, 2.5 to 17.6). The rates of recurrent ischemic events and heart failure during hospital stay also increased in a stepwise fashion among the groups, whereas creatine kinase-MB levels were similar. Among the 437 patients that were catheterized within 6 months, the prevalence of left main or 3-vessel coronary artery disease in the 3 groups was 22.0%, 42.6%, and 66.3%, respectively (P<0.001).

CONCLUSIONS

Lead aVR contains important short-term prognostic information in patients with a first non-ST-segment elevation acute myocardial infarction. Because the poorer outcome predicted by ST-segment elevation in lead aVR seems to be related to a more severe coronary artery disease, an early invasive approach might be especially beneficial in patients presenting with this finding.

Authors+Show Affiliations

Unitat Coronària, Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain. jabarrab@vhebron.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

12885742

Citation

Barrabés, José A., et al. "Prognostic Value of Lead aVR in Patients With a First non-ST-segment Elevation Acute Myocardial Infarction." Circulation, vol. 108, no. 7, 2003, pp. 814-9.
Barrabés JA, Figueras J, Moure C, et al. Prognostic value of lead aVR in patients with a first non-ST-segment elevation acute myocardial infarction. Circulation. 2003;108(7):814-9.
Barrabés, J. A., Figueras, J., Moure, C., Cortadellas, J., & Soler-Soler, J. (2003). Prognostic value of lead aVR in patients with a first non-ST-segment elevation acute myocardial infarction. Circulation, 108(7), 814-9.
Barrabés JA, et al. Prognostic Value of Lead aVR in Patients With a First non-ST-segment Elevation Acute Myocardial Infarction. Circulation. 2003 Aug 19;108(7):814-9. PubMed PMID: 12885742.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic value of lead aVR in patients with a first non-ST-segment elevation acute myocardial infarction. AU - Barrabés,José A, AU - Figueras,Jaume, AU - Moure,Cristina, AU - Cortadellas,Josefa, AU - Soler-Soler,Jordi, Y1 - 2003/07/28/ PY - 2003/7/30/pubmed PY - 2003/9/23/medline PY - 2003/7/30/entrez SP - 814 EP - 9 JF - Circulation JO - Circulation VL - 108 IS - 7 N2 - BACKGROUND: ST-segment elevation in lead aVR has been associated with severe coronary artery lesions in patients with acute coronary syndromes, but the prognostic significance of this finding is unknown. METHODS AND RESULTS: We analyzed the initial ECG in 775 consecutive patients admitted to our center with a first acute myocardial infarction without ST-segment elevation in leads other than aVR or V1. The rates of in-hospital death in patients without (n=525) and with 0.05 to 0.1 mV (n=116) or > or =0.1 mV (n=134) of ST-segment elevation in lead aVR were 1.3%, 8.6%, and 19.4%, respectively (P<0.001). After adjustment for the baseline clinical predictors and for ST-segment depression on admission, the odds ratios for death in the last 2 groups were, respectively, 4.2 (95% CI, 1.5 to 12.2) and 6.6 (95% CI, 2.5 to 17.6). The rates of recurrent ischemic events and heart failure during hospital stay also increased in a stepwise fashion among the groups, whereas creatine kinase-MB levels were similar. Among the 437 patients that were catheterized within 6 months, the prevalence of left main or 3-vessel coronary artery disease in the 3 groups was 22.0%, 42.6%, and 66.3%, respectively (P<0.001). CONCLUSIONS: Lead aVR contains important short-term prognostic information in patients with a first non-ST-segment elevation acute myocardial infarction. Because the poorer outcome predicted by ST-segment elevation in lead aVR seems to be related to a more severe coronary artery disease, an early invasive approach might be especially beneficial in patients presenting with this finding. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/12885742/Prognostic_value_of_lead_aVR_in_patients_with_a_first_non_ST_segment_elevation_acute_myocardial_infarction_ L2 - http://www.ahajournals.org/doi/full/10.1161/01.CIR.0000084553.92734.83?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -