title: The prognostic value of a prominent Q wave in lead (-)aVR in acute anterior wall myocardial infarction.
abstract: OBJECTIVE
  This study aimed to determine the association of a prominent Q wave in lead (-)aVR with clinical, echocardiographic and angiographic findings in anterior ST elevation myocardial infarction (STEMI) and to evaluate the role of this finding in short-term and long-term outcomes.
  
  
  METHODS
  During a one-year period, 150 patients with first time anterior STEMI were screened and 121 patients with no other cardiopulmonary and renal comorbid diagnoses were included in the study. Patients were allocated into two groups based on presence or absence of a prominent Q wave in lead (-)aVR. All clinical, electrocardiographic, echocardiographic and angiographic data were recorded and compared between the groups. In-hospital adverse outcomes and mortality as well as two-year survival were also compared.
  
  
  RESULTS
  Among 121 patients (mean age: 62.8±12.5 years) 26.4% had a prominent Q wave in lead (-)aVR. The prevalence of multi-vessel disease was higher in patients with a Q wave (76.9% vs. 52.8%, p=0.03). ST-segment elevation in lead V6 was significantly more common in those with a Q wave (50% vs. 30.3%, p=0.04). Posterobasal region motion abnormality was more common in the Q wave group. (9.4% vs. 1.2% respectively, p=0.04). Overall, mortality was higher in the Q wave group; however, it was not statistically significant (15.4% vs. 9.3%, p=0.39).
  
  
  CONCLUSIONS
  In anterior STEMI, presence of a Q wave in lead (-)aVR is associated with occlusion of multiple arteries. Short- and mid-term mortality are not affected by this ECG finding.
authors.affiliation: Department of Cardiology, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Leili
authors.initials: L
authors.lastname: Pourafkari
authors.affiliation: Department of Anesthesiology, University at Buffalo, Buffalo, United States.
authors.forename: Nader D
authors.initials: ND
authors.lastname: Nader
authors.affiliation: Department of Cardiology, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Navid
authors.initials: N
authors.lastname: Heydari
authors.affiliation: Department of Cardiology, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Arezou
authors.initials: A
authors.lastname: Tajlil
authors.affiliation: Department of Cardiology, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Samad
authors.initials: S
authors.lastname: Ghaffari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System; D006801:Humans; D056989:Inferior Wall Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016019:Survival Analysis; D014421:Turkey