ST – Segment changes in lead aVR and its correlation with coronary angiography and 90 days prognosis in acute coronary syndrome patients

Abstract: BACKGROUND AND OBJECTIVES: A detailed analysis of ST segment deviation in ACS patients can predict the culprit lesion and can give a useful prognostic information in these patients. Aim of our study to assess the culprit coronary artery lesion in aVR ST segment elevation and depression. To assess the 90 days prognosis in these patients. METHODS: The study was prospective observational study. A total of 100 patients admitted with first ACS with ST segement deviation were selected. Mean age of 59.4 ± 10.05 years with 70% were male. On admission patients were categorised as aVR STE 0.5-1mm, aVR STE >1mm, aVRSTD 0.5-1mm and aVRSTD >1mm. Angiogram done in STEMI patients within 1 hour and NSTEMI or UA patients with 12 to 24 hours. WMSI and EF calculated in all patents on admission and within 90 days of follow up. RESULTS: Most common risk factors was diabetes. 51 patients presented with STEMI, 29 patients presented with NSTEMI, 20 patients with UA. STE aVR 0.5-1mm seen in more with NSTEMI, STE aVR >1mm seen more with AWMI, STD aVR 0.5-1mm seen in more in IWMI and STD aVR >1mm in LWMI and IPWMI ( P value 1mm ( P value = 0.010). In ACS with LAD and RCA as culprit lesion, aVR STE >1mm correlated with Proximal LAD lesion, STD aVR 0.5 1mm with mid RCA lesion with P value of 0.056 and 1mm patients were in Killip Class 3 and 4 ( P value 1mm and aVR STD >1mm after 3 months. EF was not improved significantly in patients with aVR STE >1mm. MACE was highest among the patients with aVR STE >1mm, which was statistically significant. INTERPRETATION AND CONCLUSION: ACS with aVR STE >1mm was associated with LMCA disease and present with high Killip class. ACS with aVR STE >1mm are less likely to improve their LV systolic function, associated with large infarct size and at high risk for major adverse cardiac event on 90 days follow up. Compairing to other ST segment deviation aVR STE >1mm is a predictive marker of poor outcome in ACS patients.