Association of aVR ST-elevation with outcomes in patients with acute coronary syndrome

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Evaluation of the lead aVR in the diagnosis of acute coronary syndrome has been neglected before.1 However, there is evidence that an ST segment elevation in that lead correlates to a significant coronary artery disease.1,2 This study aimed to determine the association with clinical outcomes of an aVR ST elevation in patients with acute coronary syndrome. Purpose Identify patients who are at high risk on presentation at the emergency department. Methods This was a retrospective cohort study. Patients aged 19 years and above who were diagnosed with either unstable angina, non ST-elevation MI or ST elevation MI were eligible subjects. The medical records of patients in a tertiary referral government hospital were evaluated. The independent variable was the lead aVR ST elevation, while the primary outcome was the in-hospital mortality. Descriptive statistics was used to summarise the demographic and clinical characteristics of the patients. Frequency and proportion was used for categorical variables, median and inter quartile range for non-normally distributed continuous variables, and mean and standard deviation for normally distributed continuous variables. Independent Sample T-test and Fisher’s Exact test was used to determine the difference of mean and frequency, respectively, between patients with and without in-hospital outcomes. Odds ratio and corresponding 95% confidence intervals from binary logistic regression was computed to determine significant predictors of in-hospital outcomes. Missing variables was neither replaced nor estimated. Null hypotheses was rejected at 0.05α-level of significance. Results There were a total of 108 patients included. Most subjects were males and aged 57-62 years old. Majority had NSTE-ACS and STEMI at presentation. Lead aVR ST elevation group had an OR of 17 (95% CI 4.38-67.50 and p < 0.001) for in-hospital mortality, compared to the group without. On coronary angiogram, these patients had either a significant left main coronary artery disease or a multi-vessel coronary artery disease. Conclusion The presence of a lead aVR ST segment elevation in patients with acute coronary syndrome at presentation in the emergency department is associated with increased in-hospital mortality.