title: Predictive Value of ST-Segment Elevation in Lead aVR for Left Main and/or Three-Vessel Disease in Non-ST-Segment Elevation Myocardial Infarction.
abstract: BACKGROUND
  ST-segment elevation in lead aVR predicts left main and/or three-vessel disease (LM/3VD) in patients with acute coronary syndromes. ST-segment elevation in lead aVR is generally reciprocal to and accompanied by ST-segment depression in precordial leads. Previous studies have assessed the independent predictive value of ST-segment elevation in lead aVR for LM/3VD in non-ST-segment elevation acute coronary syndrome and have reported conflicting results.
  
  
  METHODS
  We performed a retrospective analysis of 379 patients with non-ST-segment elevation myocardial infarction (NSTEMI). Electrocardiograms on presentation were reviewed especially for ST-segment elevation ≥0.05 mV in lead aVR and ST-segment depression ≥0.05 mV in more than two contiguous leads in any other leads.
  
  
  RESULTS
  Among 379 patients, 97 (26%) patients had ST-segment elevation in lead aVR and 88 (23%) patients had LM/3VD. Patients with ST-segment elevation in lead aVR had a higher rate of LM/3VD (39% vs. 18%; P < 0.001) and in-hospital revascularization (73% vs. 60%; P = 0.02) driven by a higher rate of in-hospital coronary artery bypass grafting (19% vs. 7%; P < 0.001) than those without ST-segment elevation in lead aVR. On multivariate analysis, ST-segment elevation in lead aVR (odds ratio [OR] 2.05; 95% confidence interval [CI] 1.10-3.77; P = 0.02) and ST-segment depression in leads V1 -V4 (OR 2.99; 95% CI 1.46-6.15; P = 0.003) were independent predictors of LM/3VD.
  
  
  CONCLUSIONS
  This study demonstrates that ST-segment elevation in lead aVR is an independent predictor of LM/3VD in patients with NSTEMI.
authors.affiliation: Department of Internal Medicine.
authors.forename: Naoki
authors.initials: N
authors.lastname: Misumida
authors.affiliation: Department of Internal Medicine.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kobayashi
authors.affiliation: Department of Cardiology, Mount Sinai Beth Israel, New York, NY.
authors.forename: John T
authors.initials: JT
authors.lastname: Fox
authors.affiliation: Department of Cardiology, Mount Sinai Beth Israel, New York, NY.
authors.forename: Sam
authors.initials: S
authors.lastname: Hanon
authors.affiliation: Department of Cardiology, Mount Sinai Beth Israel, New York, NY.
authors.forename: Paul
authors.initials: P
authors.lastname: Schweitzer
authors.affiliation: Department of Cardiology, Mount Sinai Beth Israel, New York, NY.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kanei
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D011379:Prognosis; D012189:Retrospective Studies
keywords: acute coronary syndrome; coronary artery bypass grafting; electrocardiography; lead aVR; non-ST-segment elevation myocardial infarction