Document Detail

Relationship of ST elevation in lead aVR with angiographic findings and outcome in non-ST elevation acute coronary syndromes.
MedLine Citation:
PMID:  17584554     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Limited data suggest that ST elevation (ST elevation) in aVR is associated with higher mortality and more extensive coronary artery disease in the setting of non-ST elevation acute coronary syndromes (ACS). METHODS: In the prospective Global Registry of Acute Coronary Events (GRACE) electrocardiographic substudy, the admission electrocardiograms were analyzed by a blinded core laboratory. We performed multivariable analysis to determine (1) the independent prognostic significance of ST elevation in aVR and (2) its association with significant (> or = 50% stenosis) left main or 3-vessel disease (LM/3-vd). RESULTS: Among 5064 patients with non-ST elevation ACS, 4696 had no ST elevation in aVR, 292 (5.8%) had minor (0.5-1 mm) ST elevation in aVR, and 76 (1.5%) had major (>1 mm) ST elevation in aVR; their in-hospital mortality rates were 4.2%, 6.2%, and 7.9%, respectively (P for trend =.03). At 6 months follow-up, the cumulative mortality rates were 7.6%, 12.7%, and 18.3%, respectively (log-rank P for trend <.001). However, minor and major ST elevation in aVR were not independent predictors of in-hospital or 6-month death after adjusting for other validated prognosticators in the GRACE risk model. Of the 2416 patients without prior coronary bypass surgery who underwent cardiac catheterization, the prevalence of LM/3-vd was 26.1%, 36.2%, and 55.9% for the groups with no, minor, and major ST elevation in aVR, respectively (P for trend <.001). After adjusting for other clinical characteristics, major ST elevation in aVR remained an independent predictor of LM/3-vd (adjusted odds ratio, 2.68; 95% confidence interval, 1.29-5.58; P = .008). CONCLUSION: ST elevation in aVR is less prevalent than reported in previous smaller studies. Although it is associated with higher unadjusted in-hospital and 6-month mortality, it does not provide incremental prognostic value beyond comprehensive risk stratification using the validated GRACE risk model. However, ST elevation greater than 1 mm in aVR may be useful in the early identification of LM/3-vd in ACS patients with ST depression.
Andrew T Yan; Raymond T Yan; Brian M Kennelly; Frederick A Anderson; Andrzej Budaj; José López-Sendón; David Brieger; Jeanna Allegrone; Gabriel Steg; Shaun G Goodman;
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  154     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-06-22     Completed Date:  2007-07-02     Revised Date:  2008-02-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  71-8     Citation Subset:  AIM; IM    
Division of Cardiology, St. Michael's Hospital, University of Toronto, and Canadian Heart Research Centre, Toronto, Ontario, Canada.
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MeSH Terms
Coronary Angiography*
Coronary Disease / diagnosis*,  mortality*,  radiography,  therapy
Models, Statistical
Prospective Studies
Risk Assessment
Survival Rate
Treatment Outcome
Comment In:
Am Heart J. 2008 Feb;155(2):e11; author reply e13   [PMID:  18215577 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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