Predictive Value Of T-wave Direction In Lead Avr In Patients With Acute Anterior Myocardial Infarction Treated By Primary Percutaneous Coronary Intervention

ObjectiveTo investigate the relationship between T-wave direction in lead aVR on the admissionelectrocardiography in patients with acute anterior myocardial infarction treated by primarypercutaneous coronary intervention and outcomes during hospitalization.MethodsAfter randomly selection, a total of75patients with acute anterior myocardialinfarction(mean age:59.5±11.6years;59men) undergoing primary PCI were collectedfrom February,2011to December,2012and enrolled in this retrospective study. Patientsfulfilling the following criteria were included in the study: The patients were treated withprimary PCI within12hours from the onset of symptoms (typical chest pain lasting for>30minutes,including taking nitroglycerin was invalid); Acute anterior myocardial infarctionelectrocardiogram characteristics or dynamic change (the amplitude of the ST segmentsmeasured60milliseconds after J point being≥2mm in at least two contiguous ECG leads);Troponin I (cTnI) had a dynamic development. The exclusion criteria were as follows:no indication for angioplasty, treatment with coronary bypass surgery, presence of advancedvalve disease, ventricular hypertrophy, other parts of myocardial infarction, severeelectrolyte disturbance，left or right bundle branch block, intraventricular conductiondisturbance, pacemaker rhythm, preexcitation on ECG, atrial flutter and atrial fibrillation STsegment can′t be measured accurately. The patients were subdivided into two groupsaccording to the T-wave direction in aVR based upon the admission ECG: T-wave positive(≥0mm, N=24, group A) or T-wave negative (<0mm, N=51, group B). General clinical data,CKMB, troponin I(cTNI), ST segment deviation in lead aVR, left ventricular ejectionfraction, coronary angiography results， duration of hospital stays and adverse cardiovascular events (reinfarction, malignant arrhythmia, severe heart failure, cardiogenicshock and cardiovascular mortality） at hospitalization, etc. were recorded in detail. Allstatistical studies were performed with SPSS21.0software.ResultsT-wave positive patients with acute anterior myocardial infarction who received primaryPCI had lower left ventricular ejection fraction (group A:45.04%±16.247%, group B:51.59%±10.566%, p<0.05), the duration of the patient’s hospital stays was longer (group A:9.68±2.709days, group B:55±2.424days, p<0.05) after excluding deaths. In total,38patients with multivessel lesions (group A:17; group B:21), the percentage of multivessellesions in the group A was higher than in group B (group A:70.8%, group B:41.2%,p<0.05), while sensitivity, specificity and accuracy was respectively44.7%,81.8%and62.6%. A total of38patients with serious cardiovascular events at the time ofhospitalization (group A:11; group B:5), incidence of adverse cardiovascular events athospitalization tended to be significantly higher in the group A when compared with groupB (group A:45.8%, group B:9.8%, p=0.000), while sensitivity, specificity and accuracywas68.8%,78.0%and76.0%respectively. There was no significant difference inhospitalized death (p>0.05). Based on multivariate analysis, positive T wave in the aVRlead alone remained an independent predictor of adverse cardiovascular events athospitalization (odds ratio:6.710,95%confidence interval1:1.713-26.282, p<0.05).Conclusion1. Among the patients with acute anterior myocardial infarction treated by primarypercutaneous intervention, positive T-wave in lead aVR on the admissionelectrocardiography indicates lower left ventricular ejection fraction and extended durationof survivors’ hospital stays.2. Among the patients with acute anterior myocardial infarction treated by primarypercutaneous intervention, positive T-wave in lead aVR on the admissionelectrocardiography indicates the higher incidence of multivessel lesions and adversecardiovascular events at hospitalization and is an independent predictor of adversecardiovascular events at hospitalization. 3. Positive T-wave in lead aVR on the admission electrocardiography has well clinicalvalue in assessing outcomes during hospitalization for acute anterior myocardial infarctiontreated by primary percutaneous intervention.