title: The prognostic meaning of the full spectrum of aVR ST-segment changes in acute myocardial infarction.
abstract: OBJECTIVE
  ST-elevation in lead aVR is known to be associated with a worse prognosis in patients with acute ST elevation myocardial infarction (MI) but the significance of ST depression in lead aVR has been unclear. Infarction of the inferior apex of the left ventricle may not be appreciated on the standard 12-lead electrocardiogram (ECG) except by observing ST depression in lead aVR which is reciprocal to lead V(7). We therefore determined the prognostic value of the full spectrum of aVR ST changes in patients presenting with acute ST elevation MI.
  
  
  RESULTS
  Lead aVR ST level was measured on randomization and 60 min ECGs in 15 315 patients with normal conduction from the HERO-2 trial. The outcome measure was 30-day mortality. aVR ST elevation ≥1 mm was associated with higher 30-day mortality for both inferior (22.5% for ≥1.5 mm and 13.2% for 1 mm) and anterior (23.5% for ≥1.5 mm and 11.5% for 1 mm) infarction. In contrast, deeper aVR ST depression (0, 0.5, 1, and ≥1.5 mm) was associated with higher mortality for anterior infarction (9.8, 13.2, 12.8, and 16.8%, respectively, trend P-value <0.0001) but not for inferior infarction. The resolution of aVR ST depression and ST elevation 60 min after fibrinolysis was associated with lower mortality.
  
  
  CONCLUSIONS
  There is a U-shaped relationship between 30-day mortality and aVR ST level in patients presenting with anterior but not inferior ST elevation MI.
authors.affiliation: Dunedin School of Medicine,  University of Otago, Dunedin,  New Zealand.
authors.forename: Cheuk-Kit
authors.initials: CK
authors.lastname: Wong
authors.forename: Wanzhen
authors.initials: W
authors.lastname: Gao
authors.forename: Ralph A H
authors.initials: RA
authors.lastname: Stewart
authors.forename: John K
authors.initials: JK
authors.lastname: French
authors.forename: Philip E G
authors.initials: PE
authors.lastname: Aylward
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D004562:Electrocardiography / Q000379:methods* / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents; D006493:Heparin / Q000627:therapeutic use; D006629:Hirudins; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality*; D010446:Peptide Fragments / Q000627:therapeutic use; D011379:Prognosis; D011994:Recombinant Proteins / Q000627:therapeutic use; D013300:Streptokinase / Q000627:therapeutic use
chemical_list: D000991:Antithrombins; D005343:Fibrinolytic Agents; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; D013300:Streptokinase; D001241:Aspirin; C074619:bivalirudin