The prognostic meaning of the full spectrum of aVR ST-segment changes in acute myocardial infarction

Cheuk Kit Wong; Wanzhen Gao; Ralph A.H. Stewart; John K. French; Philip E.G. Aylward; Harvey D. White

doi:10.1093/eurheartj/ehr301

The prognostic meaning of the full spectrum of aVR ST-segment changes in acute myocardial infarction

Cheuk Kit Wong, Wanzhen Gao, Ralph A.H. Stewart, John K. French, Philip E.G. Aylward, Harvey D. White

Research output: Contribution to journal › Article › peer-review

37 Citations (Scopus)

Abstract

AimsST-elevation in lead aVR is known to be associated with a worse prognosis in patients with acute ST elevation myocardial infarction (MI) but the significance of ST depression in lead aVR has been unclear. Infarction of the inferior apex of the left ventricle may not be appreciated on the standard 12-lead electrocardiogram (ECG) except by observing ST depression in lead aVR which is reciprocal to lead V7. We therefore determined the prognostic value of the full spectrum of aVR ST changes in patients presenting with acute ST elevation MI.Methods and resultsLead aVR ST level was measured on randomization and 60 min ECGs in 15 315 patients with normal conduction from the HERO-2 trial. The outcome measure was 30-day mortality. aVR ST elevation ≥1 mm was associated with higher 30-day mortality for both inferior (22.5 for ≥1.5 mm and 13.2 for 1 mm) and anterior (23.5 for ≥1.5 mm and 11.5 for 1 mm) infarction. In contrast, deeper aVR ST depression (0, 0.5, 1, and ≥1.5 mm) was associated with higher mortality for anterior infarction (9.8, 13.2, 12.8, and 16.8, respectively, trend P-value ≥0.0001) but not for inferior infarction. The resolution of aVR ST depression and ST elevation 60 min after fibrinolysis was associated with lower mortality.ConclusionThere is a U-shaped relationship between 30-day mortality and aVR ST level in patients presenting with anterior but not inferior ST elevation MI.

Original language	English
Pages (from-to)	384-392
Number of pages	9
Journal	European Heart Journal
Volume	33
Issue number	3
DOIs	https://doi.org/10.1093/eurheartj/ehr301
Publication status	Published - 1 Feb 2012
Externally published	Yes

Keywords

30-day mortality
aVR
ECG
Myocardial infarction
ST changes

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10.1093/eurheartj/ehr301

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title = "The prognostic meaning of the full spectrum of aVR ST-segment changes in acute myocardial infarction",

abstract = "AimsST-elevation in lead aVR is known to be associated with a worse prognosis in patients with acute ST elevation myocardial infarction (MI) but the significance of ST depression in lead aVR has been unclear. Infarction of the inferior apex of the left ventricle may not be appreciated on the standard 12-lead electrocardiogram (ECG) except by observing ST depression in lead aVR which is reciprocal to lead V7. We therefore determined the prognostic value of the full spectrum of aVR ST changes in patients presenting with acute ST elevation MI.Methods and resultsLead aVR ST level was measured on randomization and 60 min ECGs in 15 315 patients with normal conduction from the HERO-2 trial. The outcome measure was 30-day mortality. aVR ST elevation ≥1 mm was associated with higher 30-day mortality for both inferior (22.5 for ≥1.5 mm and 13.2 for 1 mm) and anterior (23.5 for ≥1.5 mm and 11.5 for 1 mm) infarction. In contrast, deeper aVR ST depression (0, 0.5, 1, and ≥1.5 mm) was associated with higher mortality for anterior infarction (9.8, 13.2, 12.8, and 16.8, respectively, trend P-value ≥0.0001) but not for inferior infarction. The resolution of aVR ST depression and ST elevation 60 min after fibrinolysis was associated with lower mortality.ConclusionThere is a U-shaped relationship between 30-day mortality and aVR ST level in patients presenting with anterior but not inferior ST elevation MI.",

keywords = "30-day mortality, aVR, ECG, Myocardial infarction, ST changes",

author = "Wong, {Cheuk Kit} and Wanzhen Gao and Stewart, {Ralph A.H.} and French, {John K.} and Aylward, {Philip E.G.} and White, {Harvey D.}",

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doi = "10.1093/eurheartj/ehr301",

language = "English",

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T1 - The prognostic meaning of the full spectrum of aVR ST-segment changes in acute myocardial infarction

AU - Wong, Cheuk Kit

AU - Gao, Wanzhen

AU - Stewart, Ralph A.H.

AU - French, John K.

AU - Aylward, Philip E.G.

AU - White, Harvey D.

PY - 2012/2/1

Y1 - 2012/2/1

N2 - AimsST-elevation in lead aVR is known to be associated with a worse prognosis in patients with acute ST elevation myocardial infarction (MI) but the significance of ST depression in lead aVR has been unclear. Infarction of the inferior apex of the left ventricle may not be appreciated on the standard 12-lead electrocardiogram (ECG) except by observing ST depression in lead aVR which is reciprocal to lead V7. We therefore determined the prognostic value of the full spectrum of aVR ST changes in patients presenting with acute ST elevation MI.Methods and resultsLead aVR ST level was measured on randomization and 60 min ECGs in 15 315 patients with normal conduction from the HERO-2 trial. The outcome measure was 30-day mortality. aVR ST elevation ≥1 mm was associated with higher 30-day mortality for both inferior (22.5 for ≥1.5 mm and 13.2 for 1 mm) and anterior (23.5 for ≥1.5 mm and 11.5 for 1 mm) infarction. In contrast, deeper aVR ST depression (0, 0.5, 1, and ≥1.5 mm) was associated with higher mortality for anterior infarction (9.8, 13.2, 12.8, and 16.8, respectively, trend P-value ≥0.0001) but not for inferior infarction. The resolution of aVR ST depression and ST elevation 60 min after fibrinolysis was associated with lower mortality.ConclusionThere is a U-shaped relationship between 30-day mortality and aVR ST level in patients presenting with anterior but not inferior ST elevation MI.

AB - AimsST-elevation in lead aVR is known to be associated with a worse prognosis in patients with acute ST elevation myocardial infarction (MI) but the significance of ST depression in lead aVR has been unclear. Infarction of the inferior apex of the left ventricle may not be appreciated on the standard 12-lead electrocardiogram (ECG) except by observing ST depression in lead aVR which is reciprocal to lead V7. We therefore determined the prognostic value of the full spectrum of aVR ST changes in patients presenting with acute ST elevation MI.Methods and resultsLead aVR ST level was measured on randomization and 60 min ECGs in 15 315 patients with normal conduction from the HERO-2 trial. The outcome measure was 30-day mortality. aVR ST elevation ≥1 mm was associated with higher 30-day mortality for both inferior (22.5 for ≥1.5 mm and 13.2 for 1 mm) and anterior (23.5 for ≥1.5 mm and 11.5 for 1 mm) infarction. In contrast, deeper aVR ST depression (0, 0.5, 1, and ≥1.5 mm) was associated with higher mortality for anterior infarction (9.8, 13.2, 12.8, and 16.8, respectively, trend P-value ≥0.0001) but not for inferior infarction. The resolution of aVR ST depression and ST elevation 60 min after fibrinolysis was associated with lower mortality.ConclusionThere is a U-shaped relationship between 30-day mortality and aVR ST level in patients presenting with anterior but not inferior ST elevation MI.

KW - 30-day mortality

KW - aVR

KW - ECG

KW - Myocardial infarction

KW - ST changes

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SN - 0195-668X

VL - 33

SP - 384

EP - 392

JO - European Heart Journal

JF - European Heart Journal

IS - 3

ER -

The prognostic meaning of the full spectrum of aVR ST-segment changes in acute myocardial infarction

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Keywords

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