ST-segment depression in aVr as a predictor of culprit artery and infarct size in acute inferior wall ST-segment elevation myocardial infarction

Kanei, Yumiko; Sharma, Jyoti; Diwan, Ravi; Sklash, Ron; Vales, Lori; Fox, John; Schweitzer, Paul

doi:10.1016/j.jelectrocard.2009.08.022

Cited by 10 publications

(20 citation statements)

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“…In the present study, the LCx was the culprit artery in patients with ST depression in lead aVR more than those without ST-segment depression. These results were consistent with previously reported studies (4,11,13). Accordingly, Radhakrishnan et al (4) showed that the amount of ST-segment depression in lead aVR is an accurate predictor of IRA in pateints with IWMI.…”

Section: Discussionsupporting

confidence: 94%

“…The importance of ECG changes and their relationship with the IRA was recognized in the 1980s (9). Since then, numerous studies have described various ECG criteria to identify the IRA in patients with inferior-wall STEMI (7)(8)(9)(10)(11)(12). It should be noted that lead aVR has traditionally received less attention in clinical evaluation among all ECG leads, probably because it is directionally nonadjacent to any other ECG lead (4).…”

Section: Discussionmentioning

confidence: 99%

“…In acute STEMI patients, the criteria for predicting the culprit artery are usually based on the analysis of ST-segment elevation and ST-segment depression in different leads (6)(7)(8). These criteria in isolation have shown good sensitivity for the RCA and good specificity for the LCx in previous studies (9)(10)(11)(12). However, the same prediction accuracy may not be reproducible in other populations because of heterogeneity in patients' baseline characteristics and variations in an individual's coronary anatomy.…”

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confidence: 99%

“…Apart from the commonly used ECG algorithms, ST-segment depression in lead aVR has emerged as a novel predictor of LCx involvement (4,(10)(11)(12)(13). The current of injury resulting from occlusion in the RCA is, more or less, perpendicular to the axis of lead aVR.…”

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confidence: 99%

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PREdiction of ST deviations in lead aVR as a noninvasive tool to predict the infarct-Related coronary artery in patients with acute Inferior-wall Myocardial Infarction (The PREST-RIMI Study)

Sinha¹,

Mishra²

2016

Curr Res Cardiol

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BACKgROunD: Acute myocardial infarction is one of the most common presentations of coronary artery disease (CAD). Although coronary angiography remains the gold standard for identification of the infarctrelated artery (IRA), conventional 12-lead electrocardiography (ECG) is an essential tool for diagnosis, risk stratification and prognosis. If specific ECG patterns can be recognized, it will be possible to determine the IRA and size of the ventricular area that is jeopardized. The existing ECG algorithms have good sensitivity for the right coronary artery (RCA) and good specificity for the left circumflex artery (LCx) as predictors of IRA in patients with acute inferior-wall myocardial infarction (IWMI), while the specificity for the RCA and sensitivity for the LCx are modest. OBjECTIVE: To evaluate deviations in lead aVR to predict IRA in patients with IWMI, and to validate several commonly used 12-lead ECG characteristics. METhODS: A total of 585 consecutive patients with a first occurrence of acute IWMI were analyzed for the association between ECG and IRA diagnosed using coronary angiography. Subsequently, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of depression in lead aVR, along with various commonly used ECG criteria for predicting the IRA, were estimated using coronary angiographic findings as the gold standard. RESuLTS: The RCA and the LCx were found to be the IRA in 415 (71%) and 170 (29%) patients, respectively. It was observed that the absence of ST depression in lead aVR, ST depression in lead I ≥0.5 mm, ST depression in lead aVL >1 mm and ST elevation in lead III > ST elevation in lead II had excellent sensitivity and specificity in predicting the RCA as the culprit vessel. Similarly, ST depression in lead aVR ≥0.5 mm, the ratio of ST depression in lead V3 to ST elevation in lead III >1.2 had excellent sensitivity and specificity in predicting the LCx as the culprit vessel. COnCLuSIOn: These findings reveal that evaluation of ST deviations in lead aVR offers good sensitivity and specificity for LCx and RCA occlusions. The authors believe that using multiple ECG criteria may provide earlier and better identification of the IRA.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

PREdiction of ST deviations in lead aVR as a noninvasive tool to predict the infarct-Related coronary artery in patients with acute Inferior-wall Myocardial Infarction (The PREST-RIMI Study)

Sinha¹,

Mishra²

2016

Curr Res Cardiol

View full text Add to dashboard Cite

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“…RCA as the culprit artery, the sensitivity and specificity were, 86% and 55%, respectively. 16 Similarly, Sun et al, investigated the sensitivity and specificity of aVR in differentiating LCx form RCA as the culprit artery for an I-AMI. The sensitivity and specificity of LCx were 70% and 94%, respectively 12 and concluded that ST depression in lead aVR is associated with a higher specificity and a good sensitivity for LCx lesion, and all patients who are suspected of having an I-AMI should be carefully examined for aVR lead.…”

Section: Discussionmentioning

confidence: 99%