Prognostic significance of ST segment depression in lateral leads I, aVL, V5 and V6 on the admission electrocardiogram in patients with a first acute myocardial infarction without ST segment elevation

Barrabés, José A.; Figueras, Jaume; Moure, Cristina; Cortadellas, Josefa; Soler‐Soler, Jordi

doi:10.1016/s0735-1097(00)00630-6

Cited by 56 publications

(29 citation statements)

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“…Not surprisingly, ST-segment elevation in lead aVR was also related to ST-segment depression in other leads, a finding with well-known adverse prognostic implications. [2][3][4][5][6][7][8][9][10][11] Because lead aVR points at Ϫ150 degrees in the frontal plane (or inverted lead aVR at ϩ30 degrees), ST-segment elevation in this lead was especially associated with lateral or to a minor extent inferior ST-segment depression. However, STsegment elevation in lead aVR was superior to ST-segment depression elsewhere in predicting the risk of death even after adjusting for the location of ST-segment depression, which had incremental prognostic value in our previous study.…”

Section: Discussionmentioning

confidence: 99%

“…However, STsegment elevation in lead aVR was superior to ST-segment depression elsewhere in predicting the risk of death even after adjusting for the location of ST-segment depression, which had incremental prognostic value in our previous study. 7 The particular orientation of inverted lead aVR falling between leads I and II and not matching exactly the lateral or the inferior leads may help explain these results.…”

Section: Discussionmentioning

confidence: 99%

“…Anterior, inferior, and lateral ST-segment depressions were defined as ST-segment depression Ն0.1 mV in Ն2 leads oriented anteriorly (V 1 through V 4 ), inferiorly (II, III, aVF), or leftward (I, aVL, V 5 , or V 6 ), respectively. 7 The presence of T-wave inversion was also determined.…”

Section: Electrocardiographic Evaluationmentioning

confidence: 99%

“…1 The ECG has been extensively used for this purpose, and ST-segment depression on admission is now recognized as one of the strongest predictors of an adverse outcome. [2][3][4][5][6][7][8][9][10][11] In these patients, ST-segment depression has also been related to the presence of extensive coronary artery disease 3,6,8,12 and to a greater benefit of an early invasive therapeutic approach. 12,13 Lead aVR, whose positive pole is oriented to the right upper side of the heart, usually gives a mirror image of the leads oriented leftward, for which reason it is often ignored.…”

mentioning

confidence: 99%

“…Part of these patients had been included in a previous study assessing the significance of the extent and distribution of ST-segment depression, in which lead aVR was not considered. 7 …”

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confidence: 99%

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Prognostic Value of Lead aVR in Patients With a First Non–ST-Segment Elevation Acute Myocardial Infarction

et al. 2003

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Background-ST-segment elevation in lead aVR has been associated with severe coronary artery lesions in patients with acute coronary syndromes, but the prognostic significance of this finding is unknown. Methods and Results-We analyzed the initial ECG in 775 consecutive patients admitted to our center with a first acute myocardial infarction without ST-segment elevation in leads other than aVR or V 1 . The rates of in-hospital death in patients without (nϭ525) and with 0.05 to 0.1 mV (nϭ116) or Ն0.1 mV (nϭ134) of ST-segment elevation in lead aVR were 1.3%, 8.6%, and 19.4%, respectively (PϽ0.001). After adjustment for the baseline clinical predictors and for ST-segment depression on admission, the odds ratios for death in the last 2 groups were, respectively, 4.2 (95% CI, 1.5 to 12.2) and 6.6 (95% CI, 2.5 to 17.6). The rates of recurrent ischemic events and heart failure during hospital stay also increased in a stepwise fashion among the groups, whereas creatine kinase-MB levels were similar. Among the 437 patients that were catheterized within 6 months, the prevalence of left main or 3-vessel coronary artery disease in the 3 groups was 22.0%, 42.6%, and 66.3%, respectively (PϽ0.001). Conclusions-Lead aVR contains important short-term prognostic information in patients with a first non-ST-segment elevation acute myocardial infarction. Because the poorer outcome predicted by ST-segment elevation in lead aVR seems to be related to a more severe coronary artery disease, an early invasive approach might be especially beneficial in patients presenting with this finding.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Electrocardiographic Evaluationmentioning

confidence: 99%

mentioning

confidence: 99%

“…Part of these patients had been included in a previous study assessing the significance of the extent and distribution of ST-segment depression, in which lead aVR was not considered. 7 …”

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confidence: 99%

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