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Eur Heart J. 2010 Aug;31(15):1845-53. doi: 10.1093/eurheartj/ehq161. Epub 2010 May 31.

aVR ST elevation: an important but neglected sign in ST elevation acute myocardial infarction.

Author information

1
Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.

Abstract

AIM:

This study evaluated the prognostic implications of aVR ST elevation during ST elevation acute myocardial infarction (AMI).

METHODS AND RESULTS:

The Hirulog and Early Reperfusion/Occlusion-2 study randomized 17 073 patients with acute ST elevation AMI within 6 h of symptom onset to receive either bivalirudin or heparin, in addition to streptokinase and aspirin. The treatments had no effect on the primary endpoint of 30-day mortality. Electrocardiographic recordings were performed at randomization and at 60 min after commencing streptokinase. aVR ST elevation > or =1 mm was associated with higher 30-day mortality in 15 315 patients with normal intraventricular conduction regardless of AMI location (14.7% vs. 11.2% for anterior AMI, P = 0.0045 and 16.0% vs. 6.4% for inferior AMI, P < 0.0001). After adjusting for summed ST elevation and ST depression in other leads, associations with higher mortality were found with aVR ST elevation of > or =1.5 mm for anterior [odds ratio 1.69 (95% CI 1.16 to 2.45)] and of > or =1 mm for inferior AMI [odds ratio 2.41 (95% CI 1.76 to 3.30)]. There was a significant interaction between aVR ST elevation and infarct location. Thirty-day mortality was similar with anterior and inferior AMI when aVR ST elevation was present (11.5% vs. 13.2%, respectively, P = 0.51 with 1 mm and 23.5% vs. 22.5% respectively, P = 0.84 with > or = 1.5 mm ST elevation). After fibrinolytic therapy, resolution of ST elevation in aVR to <1 mm was associated with lower mortality, while new ST elevation > or =1 mm was associated with higher mortality.

CONCLUSION:

aVR ST elevation is an important adverse prognostic sign in AMI.

Comment in

PMID:
20513728
PMCID:
PMC2913115
DOI:
10.1093/eurheartj/ehq161
[Indexed for MEDLINE]
Free PMC Article

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