The Value Of Lead AVR ST-Segment Deviation For Diagnosis To Coronary Lesion And Pognosis In Patients With Acute Coronary Syndrom

Objective:To discuss the relationship between ECG lead aVR ST-segment deviation and diseased coronary artery in patients with acute coronary syndrome (ACS),evaluate its predictive value for diseased coronary artery;and analyze the relationship among lead aVR ST-segment deviation,the diseased coronary artery and GRACE risk score.Methods:Choosed 274 cases of patients with ACS in the People’s Hospital of Guangxi Zhuang Autonomous Region from January 2014 to December 2015.all patients diagnosis met the criterion of 2012 non ST-elevation acute coronary syndrome diagnosis and treatment guidelines and 2015 acute ST-elevation myocardial infarction diagnosis and treatment guidelines.according to lead aVR ST-segment deviation, the cases were devided into three groups(named A,B,C). group A raised to 0.05 mV (160 cases), group B had no deviation(81 cases), group C depressed to 0.05 mV(33 cases).based on the amplitude of lead aVR ST-segment elevation,put group A divide into two subgroups (named Ⅰ,Ⅱ):group Ⅰ that STaVR was higher than or equal to 0.1 mV, group Ⅱ that STaVR was higher than or equal to 0.05 mV,but lower than 0.1 mV.compare baseline data,laboratory examination results,GRACE risk score and therapy ect. in patients of three groups;analyze the relationship between lead aVR ST-segment deviation and the related diseased coronary artery,evaluate diagnostic value for diseased coronary artery at the same time;than analyze the relationship among the lead aVR ST-segment deviation,the diseased coronary artery and the GRACE risk score in three groups.Results:1.the result of comparing baseline data,laboratory examination results,GRACE risk score and therapy ect. in patients of three groups showed that:group A and group C had significanly higher incidence in age, MACE, GRACE risk score,in-hospital mortality than group B. the difference of group A and group B,group B and group C had statistical significance(P<0.05),but there was no statistical significance in group A and group C(P>0.05).comparing with group B, group A had higher incidence of heart faction killip class and lower left ventricular ejection fraction.2.the result of comparing the diseased coronary artery in patients of three groups showed that:①when lead aVR ST-segment elevated,the incidence of LM or 3-vessel lesion was significantly higher than the groups without elevation;② when lead aVR ST-segment deviated,having one of LM or 3-vessel and proximal LAD lesion was higher than the group without deviation.3.the diagnostic test results that STaVR deviation predicted diseased coronary artery in patients with ACS showed that:①when lead aVR ST-segment elevated, sensitivity(Se),specificity(Sp), positive predictive value(PPV) and negative predictive value(NPV) for LM lesion were 88.5%,48.6%,28.8% and 94.7% respectively;Se,Sp,PPV,NPV for 3-vessel lesion were 61.5%,42.9%,30% and 73.7% respectively;Se,Sp,PPV,NPV for having one of LM or 3-vessel and proximal LAD lesion were 67.5%,72.6%,89.4% and 39.5%. ②when lead aVR ST-segment deprssed,Se,Sp,PPV,NPV for LM lesion were 0,85.1%,0 and 78.4% respectively;Se,Sp,PPV,NPV for 3-vessel lesion were 10.8%,88.2%,42.4% and 52.7% respectively;Se,Sp,PPV,NPV for having one of LM or 3-vessel and proximal LAD lesion were 11.8%,87.1%,75.8% and 22.4%.4.the result of comparing in-hospital MACE in patients of three groups showed that:there had statistical significance in patients of three groups,and the difference of group A and group B, group B and group C had statistical significance respectively (P<0.05), instead,there was no statistical significantce in group A and group C (χ2=20.219,P> 0.05).so the in-hospital MACE incidengce in the groups of lead aVR ST-segment deviation was significantly higher than the group without deviation, especially in malignant arrhythmia(ventricular tachycardia and ventricular fibrillation),cardiogenic death, cardiogenic shock.5.the result of comparing GRACE risk stratification of patients in three groups showed that:the groups with lead aVR ST-segment deviation mainly concentrated on middle-risk and high-risk group.there were 61 cases (38.1%) in middle-risk and 85 cases(53.1%)in high-risk in group A.there were 9 cases (27.3%)in middle-risk and 21 cases (63.6%) in high-risk in group C.but there was no statistical significance among three groups (χ2=4.487,P>0.05)6. the result of comparing the two subgroups of the different amplitude of lead aVR ST-segment elevation in group A showed that:there had no statistical significance in baseline data,laboratory examination ect.but group I had higher incidence of age,heart fuction killip class,LM and in-hospitai MACE including deaths than group I obviously,even higher GRACE risk score and in-hospital mortality.7. the result of using in-hospital MACE as the dependent variable to establish Logistic regression model showed that:patients with heart function killip class≥Ⅱ occurred clinical in-hospital MACE:odds ratio=9.511,95% CI:3.838-23.571,P<0.05. ①patients with lead aVR ST-segment elevation≥ 0.05mV occurred clinical in-hospital MACE:odds ratio=7.404,95%CI: 1.897-28.895,P<0.05.②patients with lead aVR ST-segment depression≥ 0.05mV ccurred clinical in-hospital MACE:odds ratio= 18.939,95% CI:4.002-89.634, P<0.05.Conclusion:1. aVR ST-segment elevation had a high predictive value for LM or 3-vessel lesion and in-hospital MACE, and as the increasing of the amplitude of lead aVR ST-segment,as did LM or 3-vessel lesion and in-hospital MACE have a higher incidence rate, and the higher GRACE risk score and in-hospital mortality risk in patients with acute coronary symdrome.2.lead aVR ST-segment deviation is a simple and convenient method to predict the risk and prognosis of ACS, and is also an important and independent predictor for in-hospital MACE.3.lead aVR ST-segment deviation can hepl to evaluate the risk stratification,than adopt appropriate measures,only can reduce mortality,and improve the prognosis.