ST-segment elevation resolution in lead aVR a strong predictor of adverse outcomes in patients with non-ST-segment elevation acute coronary syndrome

Abstract

Background The impact of ST-segment elevation resolution in lead aVR on outcomes in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) is unclear. Methods and Results Electrocardigrams (ECGs) were recorded on admission and 6h later in 367 patients with NSTE-ACS. ST-segment deviation ≥0.5mm was considered significant: 92 patients had ST-segment elevation in lead aVR on admission ECG (ST↑aVR), and 275 did not. Among patients with ST↑aVR, 50 had ST resolution, defined as a reduction >50% in the degree of ST-segment elevation in lead aVR from admission to 6h later, and 42 did not. ST↑aVR without ST resolution was associated with older age, greater ST-segment depression in other leads on admission and 6h later, higher rates of positive troponin T, left main and/or 3-vessel coronary disease, and adverse events such as death, (re)infarction, or urgent revascularization within 30 days after admission. Multivariate analysis showed that ST↑aVR without ST resolution was the strongest independent predictor of death or (re)infarction within 30 days after admission (hazard ratio 5.62, p = 0.018). Conclusions ST↑aVR without ST resolution is a strong predictor of 30-day adverse outcomes and correlates with the extent and severity of coronary artery disease in patients with NSTE-ACS.