title: ST-segment elevation of right precordial lead (V4 R) is associated with multivessel disease and increased in-hospital mortality in acute anterior myocardial infarction patients.
abstract: BACKGROUND
  ST segment elevation of chest lead V4 R is associated with worse prognosis in acute inferior ST-elevation myocardial infarction (STEMI). This study tried to determine the relationship between ST elevation in the right precordial lead V4 R and acute anterior STEMI.
  
  
  METHODS
  Prospective study of 144 consecutive anterior STEMI patients: all had 15-lead ECG recordings (12 conventional leads and V3 R-V5 R) obtained. Patients were classified into two groups on the basis of presence (Group I, 50 patients) or absence (Group II, 94 patients) of ST-segment elevation ≥0.5 mm in lead V4 R.
  
  
  RESULTS
  Multivessel involvement was significantly higher in Group I compared with Group II (54% and 23% respectively, P < 0.001). Major adverse cardiac events and in-hospital mortality was also significantly higher for those in Group I (P < 0.02 for both). A significant correlation was found between in-hospital mortality and those in Group I (P = 0.03, OR: 6.27, CI: 1.22-32.3). There was an independent relationship between in-hospital mortality and V4 R-ST elevation (P = 0.03, OR: 11.64, CI: 1.3-27.4).
  
  
  CONCLUSIONS
  ST segment elevation in chest lead V4 R is associated with multivessel disease and increased in-hospital mortality in patients with anterior STEMI that had undergone primary percutaneous coronary intervention to the left anterior descending artery.
authors.affiliation: Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey.
authors.forename: Eyyup
authors.initials: E
authors.lastname: Tusun
authors.affiliation: Clinic of Cardiology, Kadirli Government Hospital, Osmaniye, Turkey.
authors.forename: Mahmut
authors.initials: M
authors.lastname: Uluganyan
authors.affiliation: Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Ugur
authors.affiliation: Clinic of Cardiology, Osmancik Government Hospital, Corum, Turkey.
authors.forename: Gurkan
authors.initials: G
authors.lastname: Karaca
authors.affiliation: Department of Cardiology, University Hospital Coventry, Coventry, United Kingdom.
authors.forename: Faizel
authors.initials: F
authors.lastname: Osman
authors.affiliation: Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey.
authors.forename: Bayram
authors.initials: B
authors.lastname: Koroglu
authors.affiliation: Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Murat
authors.affiliation: Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ekmekci
authors.affiliation: Clinic of Cardiology, Bezmialem University Hospital, Istanbul, Turkey.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Uyarel
authors.affiliation: Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Sahin
authors.affiliation: Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Eren
authors.affiliation: Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Bolca
mesh_terms: D000208:Acute Disease; D003331:Coronary Vessels / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000503:physiopathology*; D011446:Prospective Studies
keywords: V4R; anterior myocardial infarction; in-hospital mortality; left anterior descending artery; major adverse cardiac events