How much does AVR ST change help stratify patients with coronary disease?

Resolution of ST depression after fibrinolysis can be more important than resolution of ST elevation for many patients with inferior STEMIs

“…Lead aVR ST elevation ≥ 1 mm was present in 14.2% of the 565 and in 10.3% of the 2085 with lateral ST depression, but was almost absent in the other subgroups. Leads V 5 ,V 6 ,I and lead aVR are somewhat reciprocal [4,5] explaining the more frequent aVR ST elevation in those with V 5 ,V 6 ,I ST depression. In our previous studies [6,7], aVR ST elevation conferred a higher mortality risk in patients with inferior STEMI corroborating with the current findings of higher mortality in those with V 5 ,V 6 ,I ST depression.…”

Reperfusion therapy for ST-segment elevation myocardial infarction: has ECG information been underutilized?

“…According to some primary PCI operators, isolated aVR ST elevation with tall precordial T wave can be the only findings in patients with proximal left anterior descending coronary artery occlusion [33]. Earlier angiographic studies in STEMI patients had clearly demonstrated a positive correlation between aVR ST elevation and having a left main or proximal left anterior descending culprits, as reviewed previously [32,34].…”

“…Because V 7 , which captures ST changes from the postero-apical left ventricle, is not on standard 12-lead recording, lead aVR contains unique information. For non-ST elevation acute coronary syndrome (i.e., left ventricular subendocardial ischemia), there is a graded relationship found between aVR ST elevation and mortality [34]. While this is likely explained by extensive (from anterior to posterior) apical sub-endocardial ischemia, the possibility exists that someone exhibiting aVR ST elevation are actually having transmural ischemia from the high interventricular septal region.…”