Document Detail


aVR ST elevation: an important but neglected sign in ST elevation acute myocardial infarction.
MedLine Citation:
PMID:  20513728     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Cheuk-Kit Wong; Wanzhen Gao; Ralph A H Stewart; Jocelyne Benatar; John K French; Philip E G Aylward; Harvey D White;
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-05-31
Journal Detail:
Title:  European heart journal     Volume:  31     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-02     Completed Date:  2011-07-28     Revised Date:  2011-08-03    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1845-53     Citation Subset:  IM    
Affiliation:
Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Pressure / physiology
Bundle-Branch Block / mortality,  psychology
Electrocardiography / mortality*
Female
Humans
Male
Middle Aged
Myocardial Infarction / mortality*,  physiopathology
Risk Factors
Comments/Corrections
Comment In:
Nat Rev Cardiol. 2010 Sep;7(9):476   [PMID:  20806459 ]

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


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