title: The presence of ST-elevation in lead aVR predicts significant left main coronary artery stenosis in cardiogenic shock resulting from myocardial infarction: the Manitoba cardiogenic shock registry.
abstract: BACKGROUND
  Electrocardiographic (ECG) predictors of significant angiographic left main coronary artery stenosis (LMCS>50%) have been described in acute myocardial infarction using ST-segment elevation in lead aVR (aVR-STE). However, there is a paucity of data on its association with LMCS>50% in the setting of cardiogemic shock (CGS).
  
  
  METHODS
  We investigated 210 consecutive, unselected, patients from Sept. 2002-2006 with CGS due to acute myocardial infarction undergoing cardiac catheterization. Of those, 191 patients with interpretable ECG tracings for aVR-STE analysis formed our study sample. aVR-STE was defined as ST-segment elevation≥1mm in aVR while LMCS>50% on coronary angiogram was defined as any left main lesion that demonstrated >50% lumen narrowing or equivalent by direct visualization or quantitative coronary angiography analysis.
  
  
  RESULTS
  There was 59% survival to discharge of this predominantly male cohort (median age 68±12years; 31% females). Fifty three (28%) cases had aVR-STE while 27 (14%) had LMCS>50%. Of those, 16 patients who had aVR-STE also had LMCS>50% (sensitivity 59%, specificity 77%, positive predictive value 30%, negative predictive value 92% for predicting LMCS>50%). Multivariate analysis revealed that aVR-STE was the only significant predictor of LMCS>50% was (p=0.014; Odds Ratio=3.06; 95% Confidence Interval 1.26-7.47).
  
  
  CONCLUSIONS
  In CGS due to acute myocardial infarction, aVR-STE>1mm proves to be an important predictor of LMCS>50%. Such data could be helpful in further risk stratification for optimal management during CGS.
authors: Department of Cardiac Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Robin
authors: R
authors: Ducas
authors: Vignendra
authors: V
authors: Ariyarajah
authors: Roger
authors: R
authors: Philipp
authors: John
authors: J
authors: Ducas
authors: Jason
authors: J
authors: Elliott
authors: Davinder
authors: D
authors: Jassal
authors: James
authors: J
authors: Tam
authors: Philip
authors: P
authors: Garber
authors: Nasir
authors: N
authors: Shaikh
authors: Farrukh
authors: F
authors: Hussain
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology