title: Positive T wave in lead aVR as an independent predictor for 1-year major adverse cardiac events in patients with first anterior wall ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Positive T wave in lead aVR has been shown to predict an adverse in-hospital outcome in patients with anterior wall ST-segment elevation myocardial infarction (STEMI). However, the prognostic value of positive T wave in lead aVR on a long-term outcome has not been fully explored.
  
  
  METHODS
  We performed a retrospective analysis of 190 consecutive patients with first anterior wall STEMI who underwent an emergent coronary angiogram. Patients were divided into those with positive T wave > 0 mV and those with negative T wave ≦ 0 mV in lead aVR. Baseline and angiographic characteristics, and in-hospital revascularization procedures were recorded. In addition, in-hospital and 1-year major adverse cardiac events (MACE) including death, recurrent myocardial infarction, and target vessel revascularization were recorded.
  
  
  RESULTS
  Among 190 patients, 37 patients (19%) had positive T wave and 153 patients (81%) had negative T wave in lead aVR. Patients with positive T wave had higher rate of left main disease defined as stenosis ≥50% (11% vs. 2%, p = .028) than those with negative T wave. Patients with positive T wave had higher rate of 1-year MACE (38% vs. 13%, p < .001) driven by higher all-cause mortality (27% vs. 5%, p < .001). Positive T wave was an independent predictor for 1-year MACE (OR 2.74; 95% CI 1.04-7.15; p = .04).
  
  
  CONCLUSIONS
  Positive T wave in lead aVR was an independent predictor for 1-year MACE in patients with first anterior wall STEMI.
authors.affiliation: Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY, USA.
authors.forename: Akihiro
authors.identifier: http://orcid.org/0000-0003-3509-8733
authors.initials: A
authors.lastname: Kobayashi
authors.affiliation: Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY, USA.
authors.forename: Naoki
authors.initials: N
authors.lastname: Misumida
authors.affiliation: Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY, USA.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Aoi
authors.affiliation: Department of Cardiology, Mount Sinai Beth Israel, New York, NY, USA.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kanei
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging
keywords: STEMI; lead aVR; positive T wave