Key result
Lead aVL ST elevation linked to ~3.4-fold higher odds of reduced LVEF after anterior MI.
Why the study?
The relationship between chronic-phase infarct-related lesion stenosis severity and chronic left ventricular function in anterior AMI had not been adequately investigated, including the role of admission lead aVL ST elevation.
Does ST-segment elevation in lead aVL on the admission ECG determine the relationship between the severity of residual stenosis of the infarct-related lesion and chronic left ventricular function 1 month after anterior wall AMI?
Cohort (n=98)
Does ST-segment elevation in lead aVL on the admission ECG determine the relationship between the severity of residual stenosis of the infarct-related lesion and chronic left ventricular function 1 month after anterior wall AMI?
In anterior wall AMI, admission ST-segment elevation in lead aVL identifies patients (likely with proximal LAD lesions) whose 1-month left ventricular function is significantly impaired by severe residual stenosis (>=90%) even when the infarct-related artery remains patent.
Answers are grounded in this paper and cite their sources.
ST elevation in aVL may stratify chronic LV function risk by IRL stenosis severity after anterior AMI; leaves open prospective validation before clinical use.
BACKGROUND: The relationship between the severity of chronic-phase stenosis of infarct-related lesions (IRLs) and chronic left ventricular function in anterior acute myocardial infarctions (AMI) has not been adequately investigated. HYPOTHESIS: This study investigated whether ST elevation in lead aVL of admission electrocardiogram (ECG) would be a determinant factor of the relationship between the severity of stenosis of the IRL and chronic left ventricular function after anterior wall AMI. METHODS: One month after AMI, the IRL was evaluated by coronary angiography in 98 patients with anterior AMI, and left ventricular ejection fraction (LVEF) was determined using multigated radionuclide angiocardiography. Patients were classified according to the severity of the IRL: patients with 100% occlusion (Group O), patients with 90 to 99% stenosis (Group H), and patients with < or =75% stenosis (Group L). Patients with ST elevation > or =0.1 mV in the aVL lead on their admission ECG were included in the ST-elevation group, and those with ST elevation <0.1 mV were included in the non-ST-elevation group. RESULTS: The LVEF was greater in the non-ST-elevation group than in the ST-elevation group (p<0.0001), and the LVEF in a whole group as follows: Group L LVEF>Group H LVEF>Group O LVEF (p = 0.0160). In the ST-elevation group, LVEF was higher in Group L than in the other groups (p = 0.0251). There were three independent predictors of a reduced LVEF: ST-elevation in aVL [odds ratio (OR): 3.38, p = 0.0044], IRL stenosis > or =90% (OR: 2.90, p = 0.0044), and the IRL occurring in the left anterior descending artery proximal to the first diagonal branch (OR: 6.31, p = 0.0024). CONCLUSION: Left ventricular function was preserved, regardless of the severity of residual stenosis, in patients without ST elevation in aVL if the IRL was not totally occluded. In patients with ST elevation in aVL, LVEF was lower in patients with more severe stenosis, even if the IRL was patent.
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Yoshino et al. (2000) conducted a cohort in Single-vessel anterior wall acute myocardial infarction (n=98). ST-segment elevation >=0.1 mV in lead aVL on admission ECG and infarct-related lesion stenosis severity vs. ST-segment elevation <0.1 mV in lead aVL on admission ECG and lower stenosis severity (<=75%) was evaluated on Chronic left ventricular ejection fraction (LVEF) at 1 month (OR 3.38, p=0.0044). ST-segment elevation in lead aVL independently predicted reduced LVEF 1 month after anterior MI, along with >=90% stenosis.
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