Value of lead aVR in predicting acute occlusion of proximal left anterior descending coronary artery and in-hospital outcome in ST-elevation myocardial infarction: an electrocardiographic predictor of poor prognosis

Updates on the Electrocardiogram in Acute Coronary Syndromes

“…STE or STD of 1 mm or more in anterior STEMI portended a worse prognosis (compared to no STE or STD), even after correcting for STE or STD elsewhere on the ECG, but only ST depression in aVR (''reciprocal to injury in the area of lead V7'') remained significant when corrected for all other ECG and clinical factors [66]. STE in aVR of at least 0.5 mm in anterior STEMI predicts septal AMI (occlusion of the LAD proximal to the first septal perforator) with a PPV and NPV of 70 % and 80 % [63] better than STE in V1, which at a cutoff of[2.5 mm had 12 % sensitivity and 100 % specificity, with PPV and NPV of 100 and 39 % [71]. Kotoku et al [64] similarly found that STE in aVR correlated with proximal (vs. distal) LAD occlusion and was negatively correlated with a long (vs. short), or wraparound, LAD that affected the inferior wall.…”

“…Mortality is 50 %, and over 70 % present in cardiogenic shock, such that the diagnosis of severe ACS and need for cath lab activation is usually apparent from the clinical presentation, rather than the ECG. In contrast, approximately 10 % of patients with anterior STEMI have STE of at least 1 mm in aVR (as measured at 60 ms after the J-point) [66], and 25 % have at least 0.5 mm STE in aVR (as measured at 60 ms after the J-point, relative to the TP segment) [63]. STE or STD of 1 mm or more in anterior STEMI portended a worse prognosis (compared to no STE or STD), even after correcting for STE or STD elsewhere on the ECG, but only ST depression in aVR (''reciprocal to injury in the area of lead V7'') remained significant when corrected for all other ECG and clinical factors [66].…”

“…There is a body of literature in the past decade on the significance of STE in lead aVR in ACS, and especially for its significance for diagnosis of left main coronary artery (LMCA) obstruction and three-vessel disease [63][64][65][66][67][68]. The literature is confusing for a few reasons.…”

10.5937/mckg48-4068 = Diagnostic and prognostic utility of aVR lead in electrocardiogram

“…Do sličnih podataka došli su i drugi autori. Dokazano je da je elevacija ST segmenta u aVR odvodu bila nezavisni prediktor intrahospitalnog mortaliteta, koji je iznosio 19% kod bolesnika sa ST elevacijom u aVR odvodu ≥ 0,5 mm u poređenju sa 5% kod bolesnika bez registrovane ST elevacije u aVR odvodu (21).…”

Image Diagnosis: aVR, the Forgotten Lead

“…Although aVR ST-segment elevation may be an abnormal variant in supraventricular tachycardia, bundle branch blocks, left ventricular hypertrophy, or right ventricular hypertrophy, in the presence of other ischemic changes aVR ST-segment elevation is a sensitive indicator of left main, left anterior descending, or triple vessel disease. [5][6][7][8][9] Barrabés et al 6 and Kosuge et al 7 have reported aVR ST-segment elevation to be an independent risk factor for increased morbidity and mortality. Therefore, the presence of aVR ST-segment elevation, in conjunction with other ischemic changes, should be considered an ST-segment elevation myocardial infarction equivalent and warrants immediate interventional reperfusion 6,7,10 ( Figure 3).…”