Introduction: In patients presenting with STEMI treated with fibrinolysis, the presence of ST-segment deviation in ECG lead aVR has been associated with increased short-term mortality. ECG lead aVR has been considered a marker for global myocardial ischemia. Primary PCI results in greater culprit vessel patency rate and is favored in high risk patients.
Hypothesis: In patients with Anterior STEMI treated with primary PCI, after adjustment for other ECG and clinical features, the presence of ST-segment deviation in aVR will be associated with increased long-term mortality.
Methods: From 2002-2012, we identified 1358 primary PCI cases were of Anterior STEMI without RBBB or LBBB. Of these, 1282 had ECG ST-deviation could be measured in all 12-leads. Patients were followed for up to 3 years. We used Cox proportional hazard models to assess relationship between the presence of ST-deviation in lead aVR to death. We adjusted for sum absolute ST-deviation in all other ECG leads, age, diabetes, and heart failure.
Results: During 3-years of follow-up 99 patients died (7.7%). We found that the presence of at least 1mm absolute ST-deviation in aVR was associated with an increased risk of death (table). This finding remained significant after adjustment for summed absolute ST-deviation in the other 11 leads and clinical features of age, diabetes, and heart failure (adjusted HR 1.81, 95%CI 1.51-2.86). The presence of each additional 0.5mm ST-deviation in aVR was also associated with an incremental increased risk of death (table).
Conclusions: In patients with anterior STEMI, treated with primary PCI, the presence of at least 1mm ST-deviation and each additional 0.5mm ST-deviation in lead aVR were associated with increased mortality.