PROGNOSTIC VALUE OF ST-ELEVATION IN LEADS V1 FOR INFERIOR AND AVR FOR ANTERIOR STEMI UNDERGOING PRIMARY PCI

Abstract

Among patients with ST-elevation myocardial infarction (STEMI) treated with fibrinolysis, ST-elevation in leads aVR for anterior STEMI and V1 for inferior STEMI have been associated with increased mortality. For STEMI patients with these findings treated with primary percutaneous coronary intervention, we explored both acute and long term outcomes. A prospective cohort of 2070 patients with inferior STEMI and 1499 patients with anterior STEMI undergoing primary PCI were recruited into the study from Jan 1, 2002 to Dec 31, 2012. We excluded patients with left bundle branch block. At least 1mm of ST-elevation in leads V1 or aVR were the exposures of interest, for inferior or anterior STEMI patients, respectively. Using the absence of at least 1mm of ST-elevation in leads aVR for anterior STEMI and V1 for inferior STEMI as a reference, crude and adjusted odds ratios (ORs) for ventricular tachycardia/fibrillation (VT/VF) during PCI, 30-day and 1-year mortality were determined. For patients with inferior STEMI and at least 1mm ST-elevation in V1, ORs for 30-day and 1-year mortality were 1.71 (95% CI 0.90-3.26) and 1.89 (1.14-3.15), respectively; and 1.68 (0.86-3.29) and 1.92 (1.12-3.29) following adjustment. The adjusted OR of life threatening arrhythmia during PCI was 2.36 (1.40-4.00). Among those with anterior STEMI and at least 1mm ST-elevation in aVR, ORs for 30-day and 1-year mortality were 2.12 (1.14-3.97) and 1.85 (1.07-3.21); and 2.24 (1.18-4.26) and 1.97 (1.12-3.46) following adjustment. The adjusted OR of VT or VF during PCI was 3.10 (1.68-5.71). In patients undergoing primary PCI for inferior STEMI, ST-elevation in lead V1 predicts increased mortality at 1 year. Among patients with anterior STEMI, ST-elevation in lead aVR predicts increased mortality at 30 days and 1 year. Both findings were predictive of malignant ventricular arrhythmias during PCI.