Acute coronary syndrome (ACS) and electrocardiography showing ST elevation in Lead aVR>V1 are considered specific for left main coronary artery lesion and also suggest extensive anterior wall myocardial infarction. In this backdrop, we are presenting an incidental observation of an association of ST elevation in lead aVR>V1 in isolated proximal left circumflex lesion in the setting of ACS, who later underwent successful primary percutaneous coronary intervention.

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Background: Pre diabetes is a definite risk factor in cases of STEMI. This study was aimed to compare various clinical outcomes, coronary angiographic results and incidence of major adverse cardiovascular event (MACE) in prediabetic patients presented with STEMI with those of non prediabetic STEMI patients in a tertiary care centre. Methods: Study was conducted in prediabetic patients presented with STEMI whose fasting serum glucose and glycated hemoglobin level were 100-125 mg/dl and 5.7-6.4%, were respectively. Age and sex matched non prediabetic patients with STEMI was selected as control group. Demographic variables were taken. Further the clinical presentations; findings of coronary angiogram; electrocardiogram (ECG) and 2D echo; morbidity and cardiac mortality were collected and subjected to statistical analysis. Results: Total of 70 patients (35 prediabetic and 35 non prediabetic control) with ACS STEMI were included in the prospective study. The prediabetic patients with ACS STEMI were found with clinical presentation (Killip class III and IV); ECG manifestations (Tachyarrythmia); 2 D echo (Moderate and severe left ventricular dysfunction); angiographic findings (Double and Triple vessel disease, Right coronary artery(RCA), Left circumflex artery (LCX), Long Stents); morbidity (MACE and site hematoma) and cardiac mortality more than the non prediabetic control group. Conclusion:The results showed that prediabetic group had higher Killip class, more multivessel disease, higher MACE and cardiovascular mortality as compared to control group.