Clinical Value of Limb-Lead R-Wave Amplitude in Predicting Cardiac Rupture After Acute Anterior Myocardial Infarction Undergoing PCI

Background: Cardiac rupture remains a fatal complication of acute anterior myocardial infarction (AAMI), especially in the high-risk subset that develops left ventricular aneurysm (LVA). This study aimed to evaluate the predictive value of the average R-wave voltage in the electrocardiographic limb leads (AVRE) for cardiac rupture in this specific AAMI with LVA population. Methods: We conducted a retrospective, single-center study of 249 AAMI patients undergoing primary PCI, comparing 63 with cardiac rupture (CR group) to 186 without (Control group). Key inclusion criteria were typical chest pain and ST-segment elevation on ECG. AVRE was measured on admission ECG. Multivariate logistic regression and ROC curve analysis were used to identify independent predictors and assess the predictive performance of AVRE. Results: Patients with cardiac rupture had a significantly lower average limb-lead R-wave voltage (AVRE) than controls (2.33 vs 3.33 mV, p<0.001). Multivariate analysis identified AVRE and higher left ventricular ejection fraction (LVEF) as independent predictors (OR: 0.682 and 1.057, respectively; both p<0.01). The predictive performance of AVRE was significant (AUC: 0.656), with an optimal cutoff of <2.92 mV yielding a sensitivity of 74.6% and specificity of 59.7%. Conclusion: In this single-center study, a reduced AVRE (<2.92 mV) was an independent predictor of cardiac rupture in patients with AAMI and LVA, suggesting its potential as an accessible tool for risk stratification within this specific high-risk cohort.