ST segment elevation in aVR as a prognostic indicator in patients of non ST segment elevation ACS

Sharma Mukesh; Choudhary Lekharaj; Ameta Deepak; Jain Mahesh

Volume : IX, Issue : VII, July - 2020

ST segment elevation in aVR as a prognostic indicator in patients of non ST segment elevation ACS

Sharma Mukesh, Choudhary Lekharaj, Ameta Deepak, Jain Mahesh

Abstract :

Objectives: To identify and screen patients of non ST segment elevation acute coronary syndrome (NSTE–ACS) for presence of significant LM stenosis or TVD on the basis of ST segment elevation ≥ 0.5 mm in ECG so that management of patients should be planned for better outcome. Methodology: This study conducted in a tertiary cardiac care center in Northern India and enrolled 400 patients of NSTE – ACS. A 12 lead ECG was analyzed for presence or absence of ST segment elevation in aVR lead and ST segment depression in other leads. On the basis of their coronary angiographic findings, all enrolled patients divided into four groups. Patients with severe LM disease with or without TVD comprises group I, patients with severe LM equivalent disease in group II, patients with severe TVD in group III and patients with severe proximal LCX or severe ostio–proximal LAD disease in group IV. The angiographic findings of all patients correlated retrospectively with their respective ECG. Results: Among patients of NSTE–ACS a statistical significant association (P value < 0.05) was found between ST segment elevation of ≥ 0.5 mm in aVR lead and severe LM/LM equivalent disease and severe TVD as compared to no ST segment elevation in aVR lead. Age and gender was not found to have significant association with severe LM/LM equivalent disease or severe TVD. While prevalence of CAD risk factors such as diabetes, hypertension, smoking and dyslipidemia were significantly higher in severe LM/TVD patients (P value<0.05). Conclusion: ST segment elevation of ≥ 0.5 mm in aVR lead can be used to identify or screen patients of NSTE–ACS for presence of significant LM/LM equivalent disease or severe triple vessel disease and also for selection of correct management plan to improve their outcomes.