The Value Of ST-Elevation Of Lead AVR For Diagnosing Coronary Artery Disease In Non-ST-Elevation Myocardial Infarction

BackgroundLead aVR,an augmented and unipolar limb lead,is the only one located in the upper right quadrant in the heart of six axis system.Lead aVR can provide the basic informations about the right ventricular outflow tract and interventricular septum by viewing the heart from the upper right.ST-segment elevation in lead aVR is generally accompanied by other ST-segments depression in the chest leads.Some previous studies have ascertained the diagnostic value of ST-segment elevation in lead aVR for Non ST segment elevation acute coronary syndrome(NSTEMI),otherwise the related research results is not completely consistent.ObjectiveThe electrocardiograms of the patients suffered from NSTEMI with acute attack were restrospcetive analyzed in order to investigate the diagnostic value of ST-segment elevation of lead aVR for NSTEMI.MethodsThe electrocardiograms of 268 patients with myocardial infarction and accepted the coronary angiography in our hospitalwere retrospective analyzed from January 2013 to June 2017.All the patients were devided into two groups according to the alterations of the lead aVR ST-segment which were raised or not.The lead aVR ST-elevation group included 70 patients whose average age was 67(60-75).The control group whose the lead aVR was non-ST-elevation and ST depression included 198 patients whose average age was 64(54-73).The relationships of the coronary artery disease and the lead aVR ST-elevation in these two groups were investigated combined with the coronary angiography results.Results(1)Analysis of the baseline characteristics and risk factors of the two groups:There was no difference between two groups including the proportion of sex,weight(BMI≥28kg/m2),hypertension,hyperlipidemia,smoking history,family history of CAD,MI history and PCI history(P>0.05);(2)Analysis of the hemodynamic and laboratory datas of two groups:the systolic blood pressure,heart rate and the peak of troponin I of the lead aVR ST-segment elevation group were higher than the control group and there were significant difference.Morever,there was no significant difference in the Killip grade between two groups;(3)Analysis of the ECG and echocardiographic data of two groups:the incidence of other leads ST segment depression of Lead aVR ST-segment elevation group is higher than the control group(P<0.05);(4)The incidence of left main stem disease or three-vessel disease of the lead aVR ST-segment elevation group is 27(39%),which is significant lower than the control group performancing 36(18%)(P<0.05);The incidence of cardiovascular events of two groups were no difference(P>0.05),but the in-hospital time of the control group is shorter(P<0.05);(5)The regression analysis about the left main stem disease or three-vessel disease:Lead aVR ST-segment elevation is an independent predictor of left main stem or three-vessel(OR:2.64,95%CI:1.10-3.77;P<0.05);The diagnostic value and the specificity for the left main stem or three-vessel disease of ST-segment elevation in the lead aVR is more pregnant,nevertheless the sensitivity is lower.ConclusionFor the NSTEMI patients,with the lead aVR ST-segment elevation of the electr ocardiogram,the incidence of the left main stem or three-vessel disease increased an d maybe the independent predictor of the left main stem or three-vessel diseaseand,there was some certain diagnostic value.