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. 2016 Jul;21(4):389-96.
doi: 10.1111/anec.12324. Epub 2015 Nov 2.

The Value of Lead aVR ST Segment Changes in Localizing Culprit Lesion in Acute Inferior Myocardial Infarction and Its Prognostic Impact

Leili Pourafkari  1 , Arezou Tajlil  1 , Seyed Sajjad Mahmoudi  1 , Samad Ghaffari  1
Affiliations

The Value of Lead aVR ST Segment Changes in Localizing Culprit Lesion in Acute Inferior Myocardial Infarction and Its Prognostic Impact

Leili Pourafkari et al. Ann Noninvasive Electrocardiol. 2016 Jul.

Abstract

Background: Identifying infarct-related artery (IRA) in patients with inferior ST elevation myocardial infarction (STEMI) has prognostic and therapeutic benefits.

Objectives: To differentiate IRA and the location of culprit lesion in inferior STEMI, using ST segment changes in lead aVR.

Methods: ST segment changes in lead aVR were recorded in 150 patients, admitted with first inferior STEMI. The association of IRA and the location of culprit lesion with ST segment changes in aVR were investigated.

Results: ST elevation ≥ 0.5 mm in lead aVR was present in 17 patients (11.3%), ST depression ≥ 0.5 mm in 74 patients (49.3%) and 59 patients (39.3%) did not have significant ST segment changes. Right coronary artery (RCA) was the IRA in 117 patients (78%) and left circumflex artery (LCX) in 33 patients (22%). Prevalence of RCA involvement as the IRA was different in three study groups (94.1% in ST elevation group, 83.1% in isoelectric group and 70.3% in ST depression group, P = 0.049). Presence of ST elevation had a sensitivity and specificity of 13.68 % and 96.97%, for detecting RCA lesions, respectively. ST depression had 66.67% sensitivity and 55.56% specificity for identifying LCX lesions. Clinical complications were low in our study with no significant difference among patients of three groups.

Conclusions: Presence of ST elevation is highly suggestive of RCA lesions versus LCX lesions, whereas absence of ST elevation cannot rule out RCA lesions. Presence of ST depression has a moderate sensitivity and specificity for LCX lesions.

Keywords: acute inferior myocardial infarction; coronary angiography; electrocardiography.

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References

    1. Zimetbaum PJ, Josephson ME. Use of the electrocardiogram in acute myocardial infarction. N Engl J Med 2003;348(10):933–940. - PubMed
    1. Berger PB, Ryan TJ. Inferior myocardial infarction. High‐risk subgroups. Circulation 1990;81(2):401–411. - PubMed
    1. Verouden NJ, Barwari K, Koch KT, et al. Distinguishing the right coronary artery from the left circumflex coronary artery as the infarct‐related artery in patients undergoing primary percutaneous coronary intervention for acute inferior myocardial infarction 2009 2009‐11‐01 00:00:00. 1517–1521. - PubMed
    1. Chia BL, Yip JW, Tan HC, et al. Usefulness of ST elevation II/III ratio and ST deviation in lead I for identifying the culprit artery in inferior wall acute myocardial infarction. Am J Cardiol 2000;86(3):341–343. - PubMed
    1. Yamaji H, Iwasaki K, Kusachi S, et al. Prediction of acute left main coronary artery obstruction by 12‐lead electrocardiography. ST segment elevation in lead aVR with less ST segment elevation in lead V(1). J Am Coll Cardiol 2001;38(5):1348–1354. - PubMed

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