ORIGINAL ARTICLE ST segment elevation in lead aVR and coronary artery lesions in patients with acute coronary syndrome

Abstract

Introduction: Recently, the prognostic value of ST segment elevation in lead aVR in acute coronary syndrome (ACS) and its relationship with significant stenosis of the left main coronary artery (LMCAS) and three-vessel disease have been highlighted. Aim: Analysis of the relationship between ST segment elevation observed in aVR lead and angiographic severity of coronary artery disease in patients with ACS. Methods: The study involved 134 patients with ACS, including 54 subjects with ST elevation in aVR (group A) and 80 patients without elevation of ST in the same lead (group B), aged 33-78 years, mean 59.9±9.7 years. The severity of coronary artery disease was compared between the two groups. The logistic regression model was used for the analysis of factors affecting ST segment in aVR, as well as LMCAS and three-vessel disease probability. Results: In patients with ST elevation in aVR, three-vessel disease prevalence was two times higher (61.1% vs 35.0%; p <0.01), and LMCAS – three times higher (55.6% vs 17.5%; p <0.000001) than in those without ST elevation in aVR. Factors independently associated with ST elevation in aVR were LMCAS (OR 6.1; 95% CI 2.62-14.23; p <0.00005), ST segment elevation in V1 (OR 3.03; 95% CI 1.34-6.86; p <0.01) and diabetes (OR 2.89; 95% CI 1.17-7.15; p <0.05). The predictors of LMCAS were three-vessel disease and ST elevation in aVR, while the predictors of three-vessel disease were: LMCAS, diabetes, male gender and history of myocardial infarction. Conclusions: Elevation of the ST segment in aVR in the setting of acute coronary syndrome identifies patients with severe coronary artery disease. Only left main coronary artery disease, however, remains independently associated with ST segment elevation in aVR. Three-vessel disease and the left main coronary artery stenosis equivalent are not independent predictors of ST segment elevation in aVR of standard electrocardiograms recorded in patients with acute coronary syndrome.