Abstract 8948: ST-Segment Elevation in Lead aVR Strongly Predicts 3-Year Adverse Outcomes in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome
Background: In non-ST-segment elevation acute coronary syndrome (NSTE-ACS), lead aVR is referred to as a “cavity lead” and ST-segment elevation in this lead (ST↑aVR) may reflect global subendocardial ischemia in NSTE-ACS. We evaluated the prognostic value of ST↑aVR on admission ECG in patients with NSTE-ACS.
Methods: We studied 548 patients with NSTE-ACS who underwent coronary angiography during initial hospitalization. Patients with bundle branch block and left ventricular hypertrophy were excluded. Patients were divided into the 3 groups according to the degree of ST↑aVR on admission ECG: no ST↑aVR (n=378, G-A); ST↑aVR <1.0 mm (n=98, G-B); and ST↑aVR ≥1.0 mm (n=75, G-C). Troponin T (TnT), hemoglobin (Hb), high-sensitivity C-reactive protein (hsCRP), estimated glomerular filtration rate (eGFR), brain natriuretic peptide (BNP), TIMI risk score, and summed ST-segment depression in other leads were also measured on admission.
Results: There were no differences in sex or coronary risk factors except for diabetes mellitus in the 3 groups. In G-A, G-B, and G-C, age was 66±11, 68±11, and 70±11 years; the rates of diabetes mellitus were 29%, 48%, and 51%; Killip ≥2 was 5%, 20%, and 33%; positive TnT was 30%, 45%, and 56%; TIMI risk core was 3±1, 4±1, and 4±2; the levels of Hb were 14±2, 13±2, and 12±2 g/dl; hsCRP was 0.349±1.594, 0.640±1.936, and 0.830±1.740 mg/dl; eGFR was 67±24, 59±28, and 53±27 ml/min/1.73 m2; BNP was 149±248, 385±339, and 445±407 pg/ml; summed ST-segment depression was 2±2, 6±4, and 13±7 mm; the rates of left main or 3-vessel disease were 8%, 44%, and 72%; and major adverse events (death, [re]infarction, urgent revascularization, or congestive heart failure) at 3 years were 15%, 38%, and 55%, respectively (all p<0.01). After adjusting for baseline characteristics, multivariate analysis showed that as compared with no ST↑aVR, the hazard ratios (95% CI) for 3-year adverse events associated with ST↑aVR <1.0 mm and ST↑aVR ≥1.0 mm were 1.71 (1.08-6.69; p=0.030) and 3.29 (1.39-7.76; p=0.007), respectively.
Conclusions: In patients with NSTE-ACS, greater ST↑aVR on admission ECG is strongly associated with poorer clinical outcomes at 3 years. Our findings suggest the importance of ST↑aVR in early risk stratification.
- © 2012 by American Heart Association, Inc.