Document Detail

aVR ST elevation: an important but neglected sign in ST elevation acute myocardial infarction.
MedLine Citation:
PMID:  20513728     Owner:  NLM     Status:  MEDLINE    
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.
Cheuk-Kit Wong; Wanzhen Gao; Ralph A H Stewart; Jocelyne Benatar; John K French; Philip E G Aylward; Harvey D White;
Related Documents :
2317888 - Importance of the great vessels in the genesis of the electrocardiogram.
10396668 - Is the shortening of the qtc interval in q-wave leads showing st segment shift during e...
17016998 - Primary percutaneous coronary intervention in patients with acute myocardial infarction.
14691898 - Reversible myocardial dysfunction, a possible complication in critically ill patients w...
301968 - Treatment of post-myocardial infarction angina by intra-aortic ballon pumping and emerg...
21785808 - Consensus document: antithrombotic therapy in patients with atrial fibrillation undergo...
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    
Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Blood Pressure / physiology
Bundle-Branch Block / mortality,  psychology
Electrocardiography / mortality*
Middle Aged
Myocardial Infarction / mortality*,  physiopathology
Risk Factors
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

Previous Document:  Acute myocardial infarction secondary to direct myocardial infiltration by a malignant neoplasia.
Next Document:  Clinicopathological profiles of progressive heart failure in hypertrophic cardiomyopathy.