Abstract 11177: No ST-Segment Elevation Resolution in Lead aVR Strongly Predicts In-hospital Adverse Outcomes in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome
Introduction: ST-segment elevation in lead aVR (ST↑aVR) on admission ECG is considered a useful predictor of left main/3-vessel disease (LM/3VD) and poor outcomes in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). However, the prognostic value of the change in ST↑aVR after admission remains unclear.
Hypothesis: ST-segment analysis of lead aVR after admission may facilitate risk stratification in NSTE-ACS.
Methods: We studied 706 patients with NSTE-ACS undergoing coronary angiography during hospitalization. ECGs were recorded on admission and 6 h after admission. ST↑aVR ≥0.5 mm was considered significant. A reduction of >50% in ST↑aVR between the value on admission and that 6 h later was defined as ST resolution. Patients were classified into the 3 groups according to ECG findings: G-A, no ST↑aVR on admission (n=526); G-B, ST↑aVR on admission with ST resolution (n=114); and G-C, ST↑aVR on admission without ST resolution (n=66). Troponin T (TnT), estimated glomerular filtration rate (eGFR), brain natriuretic peptide (BNP), high-sensitivity C-reactive protein (hsCRP), and summed ST-segment depression (ST↓) were measured on admission.
Results: There were no significant differences in sex or coronary risk factors except for diabetes mellitus in the 3 groups. In G-A, G-B, G-C, age was 66±11, 69±11, and 70±11 years; the rates of diabetes mellitus were 29%, 43%, and 55%; Killip ≥2 was 4%, 18%, and 27%; and positive TnT was 27%, 42%, and 53%; the levels of eGFR were 67±24, 61±27, and 54±28 ml/min/1.73 m2; BNP was 148±274, 358±418, and 617±545 pg/ml; hsCRP was 0.414±2.008, 0.655±1.551, and 1.125±2.058 mg/dl; summed ST↓ was 2±2, 7±4, and 11±7 mm; the rates of LM/3VD were 6%, 38%, and 86%; and in-hospital adverse events (death, [re]infarction, or urgent revascularization) were 6%, 17%, and 35%, respectively (all p<0.01). Multivariate analysis showed that as compared with no ST↑aVR , hazard ratios (95% CI) for in-hospital adverse events associated with ST↑aVR with ST resolution and that without ST resolution were 1.60 (0.68-4.38; p=0.25), and 6.11 (2.07-14.9; p<0.001), respectively.
Conclusions: No resolution of ST↑aVR, ie., persistent ST↑aVR 6 h after admission, strongly predicts in-hospital adverse outcomes in patients with NSTE-ACS.
Author Disclosures: M. Kosuge: None. T. Ebina: None. K. Hibi: Research Grant; Modest; AstraZeneca Co., Ltd, MSD Co., Ltd, Solve Co., Ltd, Biosensors Japan Co., Ltd, Teijin Pharma Co., Ltd, Terumo Co., Ltd, Mochida Pharmaceutical Co., Ltd. Research Grant; Significant; Goodman Co., Ltd, Medtronic Japan Co., Ltd, St. Jude Medical Japan Co., Ltd. Honoraria; Modest; Daiichi-Sankyo Co., Ltd, Boston Scientific Japan Co., Ltd. Consultant/Advisory Board; Modest; Terumo Co., Ltd, St. Jude Medical Japan Co., Ltd. N. Iwahashi: None. N. Maejima: None. Y. Matsuzawa: None. K. Kimura: Research Grant; Significant; Toa Eiyo Ltd, Bayer, MSD, Astellas, Astrazeneca, Sanofi, Eli Lilly Japan, Research Institute for Production Development, Pfizer, Shionogi, Kowa-souyaku, Daiichi-Sankyo, Mitsubishi Tanabe, Nihon-Boehringer-Ingelheim, Takeda, Otsuka, Ono. Honoraria; Modest; Astrazeneca, Toa Eiyo Ltd. Honoraria; Significant; MSD, Bayer, Daiichi-Sankyo.
- © 2016 by American Heart Association, Inc.