Abstract 9739: Predictive Values of ST-segment Elevation in Lead aVR for the Diagnosis of Left Main or 3-Vessel Disease in Patients With Non-ST-segment Elevation Acute Coronary Syndrome
Introduction: In patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), early identification of left main or 3-vessel disease (LM/3VD) is important in selecting the optimal treatment strategy.
Hypothesis: ST-segment elevation in lead aVR (ST↑aVR) at presentation is considered a useful predictor of LM/3VD; however, time from symptom onset to presentation may influence its predictive value.
Methods: We studied 835 patients with NSTE-ACS undergoing coronary angiography during hospitalization. We evaluated ECG findings and troponin T (TnT), estimated glomerular filtration rate (eGFR), brain natriuretic peptide (BNP), high-sensitivity C-reactive protein (hsCRP), and TIMI risk score on admission.
Results: The prevalence of LM/3VD was 21%. Patients with LM/3VD were older (70±11 vs 66±11 yrs), had higher rates of hypertension (72% vs 64%), diabetes mellitus (51% vs 30%), Killip class ≥2 (31% vs 6%), positive-troponin T (≥0.1 ng/ml) (57% vs 29%), and ST↑aVR ≥0.5 mm (79% vs 15%), and had higher levels of BNP (367±407 vs 184±398 pg/ml), hsCRP (0.908±2.564 vs 0.371±1.425 mg/dl), and summed ST-segment depression (9±7 vs 2±3 mm), and TIMI risk score (3.7±1.2 vs 2.6±1.4) and a lower eGFR (54±27 vs 66±24 ml/min/1.73 m2), and a higher rate of in-hospital death, (re)infarction, or urgent revascularization (36% vs 9%) than did those without LM/3VD (all p<0.05). Multivariate analysis showed that ST↑aVR (OR 10.8, 95%CI 3.88-20.1, p<0.01) was the strongest predictor of LM/3VD, and followed by positive-troponin T (OR 2.20, 95%CI 1.26-4.01, p<0.01). When patients were subdivided according to the 6-h time window from symptom onset, the predictive values of ST↑aVR for the diagnosis of LM/3VD were significantly higher than those of positive-troponin T, except the sensitivity in delayed presentation (Table).
Conclusions: In patients with NSTE-ACS, ST↑aVR on admission strongly predicted LM/3VD; however, its sensitivity decreased in delayed (>6 h) presentation.
Author Disclosures: M. Kosuge: Other Research Support; Significant; Toa Eiyo Ltd. T. Ebina: None. K. Hibi: Research Grant; Modest; AstraZeneca, MSD, Solve, Biosensors Japan, Teijin Pharma, Terumo, Mochida. Research Grant; Significant; Goodman, Medtronic Japan, St. Jude Medical Japan. Honoraria; Modest; Daiichi-Sankyo, Boston Scientific Japa. Consultant/Advisory Board; Modest; Terumo, St. Jude Medical Japan. K. Tsukahara: None. N. Iwahashi: None. N. Maejima: None. E. Akiyama: None. S. Umemura: Research Grant; Modest; Torii, Dainippon-Sumitomo. Research Grant; Significant; Pfizer, Astellas, Daiichi-Sankyo, Astrazeneca, Nihon-Boehringer-Ingelheim. Honoraria; Modest; Daiichi-Sankyo, MSD, Takeda. K. Kimura: Research Grant; Significant; Toa Eiyo Ltd, Bayer, MSD, Astellas, Astrazeneca, Sanofi, Eli Lilly Japan, Research Institute for Production Development, Bayer, Pfizer, Shionogi, Kowa-souyaku, Daiichi-Sankyo, Mitsubishi Tanabe, Nihon-Boehringer-Ingelheim, Takeda, Otuka, Ono. Honoraria; Modest; Astrazeneca, Toa Eiyo Ltd. Honoraria; Significant; MSD, Bayer, Daiichi-Sankyo.
- © 2015 by American Heart Association, Inc.