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April 17, 2015Annals of Noninvasive ElectrocardiologyOpen Access

On multivariate analysis, ST-segment elevation in lead aVR ≥0.05 mV was an independent predictor of left main and/or three-vessel disease (OR 2.05; 95% CI 1.10-3.77; P = 0.02).

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Why the study?

Does ST-segment elevation in lead aVR predict left main and/or three-vessel disease in patients with NSTEMI?

Population

379 patients with non-ST-segment elevation myocardial infarction who underwent coronary angiography within 5…

Comparison

Presence of ST-segment elevation ≥0.05 mV in… vs Absence of ST-segment elevation ≥0.05 mV in lead…

Design

Cohort, ECGs obtained on presentation were reviewed by two independent…

Follow-up

In-hospital

Authors

NMNaoki MisumidaAKAkihiro KobayashiJFJohn T. Fox

Discussion

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Member takes

Overview

May support aVR elevation in NSTEMI risk assessment; hypothesis-generating and requires prospective validation before guiding management.

Structured PICO

Does ST-segment elevation in lead aVR predict left main and/or three-vessel disease in patients with NSTEMI?

P
Population
379 patients with non-ST-segment elevation myocardial infarction (NSTEMI) who underwent coronary angiography within 5 days after presentation. Inclusion criteria: troponin level >99th percentile, chest pain or ischemic ECG changes (ST depression ≥0.05 mV or T-wave inversion ≥0.1 mV in ≥2 contiguous leads), and absence of ST-segment elevation and new LBBB.
I
Intervention
Presence of ST-segment elevation ≥0.05 mV in lead aVR on presentation electrocardiogram
C
Comparator
Absence of ST-segment elevation ≥0.05 mV in lead aVR on presentation electrocardiogram
O
Outcome
Prevalence of left main and/or three-vessel disease (LM/3VD) on coronary angiographysurrogate

In patients with NSTEMI, ST-segment elevation ≥0.05 mV in lead aVR is an independent predictor of left main and/or three-vessel disease, which may help identify high-risk patients who could benefit from early invasive management.

Limitations

  • Retrospective observational study design
  • Small sample size and low in-hospital mortality rate limited the power to evaluate prognostic value
  • Did not exclude patients with posterior (inferolateral) infarction presenting with ST-segment depression in V1-V4
  • Only included patients who underwent coronary angiography, limiting generalizability

Cite This Study

Misumida et al. (2015) studied this question.

synapsesocial.com/papers/6a707ea975498292b709edc1https://doi.org/10.1111/anec.12272
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Diagnostic value of ST-segment elevation in lead aVR exceeding V1 for identifying significant left main coronary artery disease in acute coronary syndrome2026 · 1 citations
  2. 2Prognostic Value of Lead aVR in Patients With a First Non–ST-Segment Elevation Acute Myocardial Infarction2003 · 176 citations
  3. 3Prognostic Value of ST-segment Deviation in Lead aVR in Electrocardiogram in Acute Myocardial Infarction2024
  4. 4The prognostic effect of ST-elevation in lead aVR on coronary artery disease, and outcome in acute coronary syndrome patients: a systematic review and meta-analysis2022 · 14 citations
  5. 5Prediction of Left Main Coronary Artery Occlusion by ST Segment Elevation in Lead aVR Greater than that in Lead V1 in Acute Coronary Syndrome2017 · 1 citations