ST-Segment Elevation in the Right Precordial Leads in Patients with Acute Anterior Myocardial Infarction

Abstract

Background: Elevation of ST segment in leads V3R/ V4R, which is commonly encountered in right ventricular myocardial infarction, may also occur in patients with anterior ST elevation myocardial infarction (STEMI). However, the clinical impact of this finding in the setting of anterior myocardial infarction is not well understood. Aims: We aimed to investigate the prognostic value of ST segment elevation in leads V3R/V4R in patients with first acute anterior myocardial infarction. Study Design: Prospective cohort study. Methods: Right precordial leads V3R/V4R were recorded in 111 patients admitted with first time anterior myocardial infarction. Patients were allocated into two groups based on the presence or absence of ST elevation in leads V3R/V4R. Demographic, biochemical and echocardiographic data, as well as the angiographic information, were recorded. In-hospital and 3 month mortality, and major adverse cardiac events (MACE), death, heart failure and ventricular dysrhythmia were also compared. Results: ST elevation in lead V3R or V4R was present in 72 out of 111 patients (64.9%). Involvement of the proximal part of the left anterior descending (LAD) artery was not different in the two groups (44.4% of patients with elevation vs. 53.8% of patients without elevation, p=0.22). Post-myocardial infarction complications, mortality and major adverse cardiac events were similar in the two groups. Left ventricular ejection fraction (LVEF) was significantly lower in patients with ST elevation in V3R/V4R (35 %±8 vs. 38 %±8, p=0.02). Twenty three out of 111 patients (20.7%) developed heart failure, which was similar in the two groups [16 (22.2%) of patients with ST elevation vs. 7 (17.9%) of patients without ST elevation, p=0.39]. Conclusion: Although ST elevation in V3R/V4R can be present in patients with left anterior descending artery occlusion, it does not seem to predict the prognosis. Lower left ventricular ejection fraction in this group may play a role in the long-term prognosis; however, this issue needs further investigation.

The prognostic significance of early and late right precordial lead (V4R) ST‐segment elevation in patients with acute anterior myocardial infarction

“…Furthermore, we observed that the patients with late STE in V 4 R had higher SYNTAX score compared to other two groups. On the contrary, Pourafkari et al investigated the prognostic value of STE in lead V 4 R in patients with anterior STEMI and they concluded that it does not seem to predict the prognosis (Pourafkari et al, 2016). However, they found that patients with STE in lead V 4 R had lower LVEF, their study population is relatively small to reach to statistical significance.…”

“…There are several studies reported a relatively high incidence of concurrent right precordial STE in patients with anterior STEMI (Barsheshet et al, 2011;Pourafkari et al, 2016;Tusun et al, 2015).…”

“…Along with that, interventricular septum and anterior wall of the RV is partially supplied by the left anterior descending artery (LAD) (Charlap et al, 1989;Erhardt, 1974;Ratliff & Hackel, 1980). Some recent studies demonstrated a relatively high incidence of concurrent RV infarction in patients with anterior STEMI (Barsheshet et al, 2011;Bodi et al, 2010;Pourafkari et al, 2016;Tusun et al, 2015). However, less data have been reported about the prognostic importance of STE in lead V 4 R in patients with anterior STEMI and authors are in conflict on how this STE has an impact on the prognosis (Barsheshet et al, 2011;Bodi et al, 2010;Ghaffari, Taban Sadeghi, & Sayyadi, 2017;Tusun et al, 2015).…”

“…Additionally, RV infarction is considered as temporary and final infarct size is considered as small due to its thinner wall and subendocardial oxygenization (Bodi et al, 2010). The studies evaluating STE in lead V 4 R in patients with anterior STEMI only recorded admission electrocardiogram (ECG) but not postrevascularization control ECG and did not reveal long-term outcomes (Barsheshet et al, 2011;Pourafkari et al, 2016;Tusun et al, 2015). In this study, we investigated the effect of early and late STE in lead V 4 R on in-hospital and 12-month long-term outcomes in patients with first anterior STEMI.…”

The association of right coronary artery conus branch size and course with ST segment elevation of right precordial leads and clinical outcome of acute anterior myocardial infarction

“…STE in lead V4R can indicate right ventricular infarction in patients with inferior infarction, which is associated with a poor prognosis and can lead to arrhythmias and conduction disorders and VF. 1 - 3 Limited data indicated that STE in lead V4R in patients with anterior infarction is associated with a poor prognosis. 4 …”