title: Prognostic value of lead aVR in patients with a first non-ST-segment elevation acute myocardial infarction.
abstract: BACKGROUND
  ST-segment elevation in lead aVR has been associated with severe coronary artery lesions in patients with acute coronary syndromes, but the prognostic significance of this finding is unknown.
  
  
  RESULTS
  We analyzed the initial ECG in 775 consecutive patients admitted to our center with a first acute myocardial infarction without ST-segment elevation in leads other than aVR or V1. The rates of in-hospital death in patients without (n=525) and with 0.05 to 0.1 mV (n=116) or > or =0.1 mV (n=134) of ST-segment elevation in lead aVR were 1.3%, 8.6%, and 19.4%, respectively (P<0.001). After adjustment for the baseline clinical predictors and for ST-segment depression on admission, the odds ratios for death in the last 2 groups were, respectively, 4.2 (95% CI, 1.5 to 12.2) and 6.6 (95% CI, 2.5 to 17.6). The rates of recurrent ischemic events and heart failure during hospital stay also increased in a stepwise fashion among the groups, whereas creatine kinase-MB levels were similar. Among the 437 patients that were catheterized within 6 months, the prevalence of left main or 3-vessel coronary artery disease in the 3 groups was 22.0%, 42.6%, and 66.3%, respectively (P<0.001).
  
  
  CONCLUSIONS
  Lead aVR contains important short-term prognostic information in patients with a first non-ST-segment elevation acute myocardial infarction. Because the poorer outcome predicted by ST-segment elevation in lead aVR seems to be related to a more severe coronary artery disease, an early invasive approach might be especially beneficial in patients presenting with this finding.
authors.affiliation: Unitat Coronària, Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain. jabarrab@vhebron.net
authors.forename: José A
authors.initials: JA
authors.lastname: Barrabés
authors.forename: Jaume
authors.initials: J
authors.lastname: Figueras
authors.forename: Cristina
authors.initials: C
authors.lastname: Moure
authors.forename: Josefa
authors.initials: J
authors.lastname: Cortadellas
authors.forename: Jordi
authors.initials: J
authors.lastname: Soler-Soler
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis*; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D004562:Electrocardiography / Q000379:methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors
chemical_list: D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form