Acute ST-segment elevation myocardial infarction: The prognostic importance of lead augmented vector right and leads V₇–V₉

Abstract

Background:Acute myocardial infarction (MI) is associated with high mortality and among survivors have high morbidity. Electrocardiogram (ECG), a cost-effective and easily available, has traditionally been used not only just for diagnosis of MI but also for culprit vessel recognition and for prognostication. However, the role of lead augmented vector right (aVR) and leads V7–V9 in acute MI are often neglected in clinical practice. We studied the role of lead aVR and leads V7–V9 in ST-elevation MI (STEMI) patients.Methods:A total of 209 patients presenting with STEMI were enrolled in the study. History of comorbid conditions and habits was enquired. Routine blood tests were performed. Full spectrum ECG (including V7–9) and 2D-ECHO was performed on all patients. All the patients underwent revascularization by primary percutaneous coronary intervention. The role of lead aVR, lead V7, and leads V8–9 was analyzed in anterior wall MI (AWMI) and inferior wall MI. All the patients were followed up for 1 month for outcome assessment.Results:Of the 209 patients, 85.1% were males and 35.8% were diabetic, 60.2% were smokers, AWMI accounted for 55.5%. Lead aVR ST deviation was noted in 75.1% of patients (elevation in 17.7% and depression in 47.1%). V7 ST elevation occurred in 27.6% and V8–9 elevation occurred in 7.5% of the study population. Total death was 11.9% in the study (including the in-hospital mortality), all these patients had lead aVR ST segment deviation (P < 0.001).Conclusion:Lead aVR ST deviation and Lead V7 ST deviation helps to prognosticate the STEMI patients as high risk and those with aVR ST depression had higher mortality compared to aVR ST elevation because of larger myocardial involvement.

Synthesized 18-Lead Electrocardiogram in Diagnosing Posterior Stemi-Equivalent Acute Coronary Syndrome in Patients with NSTEMI

“…e European Society of Cardiology and American Heart Association/American College of Cardiology guidelines recommend acquiring posterior leads V7 through V9 for suspected cases of acute LCx occlusion, such as in patients with typical symptoms and an initially nondiagnostic ECG or ST-segment depression (STD) in leads V1-3 [1,2,7]. However, acquisition of posterior leads V7-9 requires meticulous reattachment from the chest to the back and is yet to be adopted in routine clinical practice [8][9][10].…”

aVR ST‐segment changes and prognosis of ST‐segment elevation myocardial infarction

“… 1 , 2 These changes have been accepted as a main source for additional information to determine culprit lesions and thus for predicting poor prognosis especially in patients with ST‐segment elevation myocardial infarction (STEMI). 3 , 4 The pathological change in ST segment in lead aVR is closely linked to anterior STEMI; however, these segmental changes among those with inferior STEMI remain inconsistent. 5 Additionally, some studies could only determine the value of ST‐segment changes in the aVR for differentiation of infarctions due to stenosis in left circumflex artery (LCX) and right coronary artery (RCA) arteries with no extra data on the influence of the site of occlusion in these arteries.…”