Key result
Lead aVR ST elevation ≥0.05 mV linked to ~7-fold higher odds of left main CAD.
Why the study?
The significance of ST-segment elevation in lead aVR for diagnosing left main coronary artery disease in Non-ST-elevation acute coronary syndrome was not comprehensively summarized.
Meta-Analysis
Odds Ratio: 6.64 (95% CI 4.8–9.17)
STE ≥0.05 mV in aVR signals higher LMD risk in NSTE-ACS; confirms independent predictive value across pooled studies.
BACKGROUND: Previous researches proved that the ST-segment elevation (STE) in lead aVR had great significance on the prediction of severe left main lesion or serious multivessel lesions. The current research is to summarize the published data and evaluate the overall association of STE in lead aVR and left main coronary artery disease (LMD) in Non-ST-elevation acute coronary syndrome. METHODS: Literature searching was performed in the online database, and a systematic review was conducted based on the searched results. Meaningful STE in lead aVR was summarized and analyzed for odds ratio (OR) and 95% confidence intervals (95% CI). RESULTS: Twenty-seven articles were included for final data analysis. Compared with STE < 0.05, STE ≥ 0.05 mV was associated with a higher incidence rate of LMD (OR = 6.64, 95% CI: 4.80 ~ 9.17), and the degree of STE in lead aVR was significantly associated with LMD. Myocardial infarction was more likely to occur in patients with STE ≥ 0.05 mV than in patients with STE < 0.05 mV (OR = 3.12, 95% CI: 1.73 ~ 5.62). CONCLUSIONS: The STE in lead aVR and the degree of STE are independent predictors in diagnosing LMD or myocardial infarction.
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Lee et al. (2019) conducted a meta-analysis in Non-ST-elevation acute coronary syndrome. ST-segment elevation ≥ 0.05 mV in lead aVR vs. ST-segment elevation < 0.05 mV was evaluated on Left main coronary artery disease (LMD) (OR 6.64, 95% CI 4.80-9.17). ST-segment elevation ≥ 0.05 mV in lead aVR was significantly associated with a higher incidence of left main coronary artery disease compared with elevation < 0.05 mV (OR 6.64; 95% CI 4.80-9.17).
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