Lead aVR ST-Segment Elevation as a Marker for Left Main Coronary Artery Disease in Acute Coronary Syndrome Patients
DOI:
https://doi.org/10.61919/jhrr.v4i2.1212Keywords:
left main coronary artery disease, aVR electrocardiography, ST-segment elevation, acute coronary syndrome, obesity smoking diagnostic markers, coronary angiography, cardiovascular risk factorsAbstract
Background: Coronary artery disease (CAD) is a leading cause of death globally, including in Pakistan. Accurate and timely identification of severe left main coronary artery disease (LM-CAD) in patients with acute coronary syndrome (ACS) is crucial for improving outcomes. ST-segment elevation in lead aVR on electrocardiogram (ECG) has been proposed as a potential marker for LM-CAD.
Objective: The study aimed to ascertain the prevalence of left main coronary artery disease in acute coronary syndrome patients exhibiting ST-segment elevation in lead aVR and to evaluate the diagnostic utility of this ECG finding.
Methods: This cross-sectional study was conducted at the Department of Cardiology, Hayatabad Medical Complex, Peshawar, KPK, Pakistan, from April 2023 to May 2024. A total of 125 patients aged 18-75 years with ST-segment elevation of >0.5mm in lead aVR were enrolled. Exclusion criteria included chronic kidney disease, severe anemia, dextrocardia, history of circulatory collapse, low ejection fraction, and prior bypass grafting. Demographic and clinical data were collected, and all patients underwent coronary angiography. Data analysis was performed using SPSS version 25.0. Quantitative variables were presented as mean ± standard deviation, while qualitative variables were expressed as frequencies and percentages. The chi-square test was used to find associations, with a p-value <0.05 considered significant. The study followed ethical guidelines, including informed consent and institutional ethical board approval.
Results: The cohort included 70.4% males and 29.6% females, with a mean age of 55.76 ± 6.5 years. Among the patients, 81.6% had LM-CAD. Significant associations were found between LM-CAD and smoking (P = 0.017) as well as obesity (P = 0.003). No significant associations were observed with age (P = 0.825) or gender (P = 0.764). Among the types of ACS, NSTEMI patients had the highest LM-CAD prevalence (48%), followed by STEMI (22.4%) and unstable angina (11.2%), with a significant association between unstable angina and LM-CAD (P = 0.048).
Conclusion: ST-segment elevation in lead aVR is a reliable indicator of left main coronary artery disease in patients presenting with acute coronary syndrome. Major cardiovascular risk factors such as smoking and obesity showed strong correlations with this ECG finding. Incorporating lead aVR analysis into routine ECG evaluations can enhance diagnostic accuracy and facilitate early therapeutic decisions, potentially improving patient outcomes.
Downloads
References
Ralapanawa U, Sivakanesan R. Epidemiology and the Magnitude of Coronary Artery Disease and Acute Coronary Syndrome: A Narrative Review. J Epidemiol Glob Health. 2021;11(2):169–177.
Sarkees ML, Bavry AA. Acute Coronary Syndrome (Unstable Angina and Non-ST Elevation MI). BMJ Clin Evid. 2009;2009:0209.
Afify H, Oliynyk V, Burke F. A Silent Killer: Left Main Coronary Artery Disease in Gastrointestinal Bleed. Cureus. 2021;13(6)
Ramadan R, Boden WE, Kinlay S. Management of Left Main Coronary Artery Disease. J Am Heart Assoc. 2018;7(7)
Dai L, Yu W, Gao M, Yu Y. Selective Coronary Vein Bypass Graft Improves Outcomes of Patients with Right Coronary Artery Lesion. J Thorac Dis. 2023;15(8):4346–4356.
Édes IF, Ruzsa Z, Lux Á, Gellér L, Molnár L, Nowotta F, et al. Acute, Total Occlusion of the Left Main Stem: Coronary Intervention Options, Outcomes, and Recommendations. Adv Interv Cardiol. 2018;14(3):233–239.
Caldonazo T, Kirov H, Riedel LL, Gaudino M, Doenst T. Comparing CABG and PCI Across the Globe Based on Current Regional Registry Evidence. Sci Rep. 2022;12(1):22164.
Bhattad PB, Sherif AA, Mishra AK, Roumia M. Left Main Coronary Artery Disease: The Forgotten Lead of Electrocardiogram Is Predictive. Cureus. 2022;14(8)
Kosuge M, Kimura K, Ishikawa T. Predictors of Left Main or Three-Vessel Disease in Patients Who Have Acute Coronary Syndromes with Non-ST-Segment Elevation. Am J Cardiol. 2005;95:1366–1369.
Morris N, Body R. BET 2: Is ST Elevation in aVR a Sure Sign of Left Main Coronary Artery Stenosis? Emerg Med J. 2016;33(1):77–80.
Barrabes JA, Figueras J, Moure C, Cortadellas J, Soler-Soler J. Prognostic Value of Lead aVR in Patients with a First Non–ST-Segment Elevation Acute Myocardial Infarction. Circulation. 2003;108:814–819.
Taglieri N, Marzocchi A, Saia F, et al. Short- and Long-Term Prognostic Significance of ST-Segment Elevation in Lead aVR in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome. Am J Cardiol. 2011;108:21–28.
Yamaji H, Iwasaki K, Kusachi S, Murakami T, Hirami R, et al. ST Segment Elevation in Lead aVR with Less ST Segment Elevation in Lead V1. J Am Coll Cardiol. 2001;38:1348–1354.
Hengrussamee K, Kehasukcharoen W, Tansuphaswadikul S. Significance of Lead aVR ST Segment Elevation in Acute Coronary Syndrome. J Med Assoc Thai. 2005;88(10):1382–1387.
Rostoff P, Piwowarska W, Konduracka E, Libionka A, Bobrowska-Juszczuk M, Stopyra K, et al. Value of Lead aVR in the Detection of Significant Left Main Coronary Artery Stenosis in Acute Coronary Syndrome. Kardiol Pol. 2005;62:128–137.
Freynhofer MK, Tajsić M, Wojta J, Huber K. Biomarkers in acute coronary artery disease. Wiener medizinische Wochenschrift (1946). 2012;162(21-22):489-98.
Laaksonen R, Ekroos K, Sysi-Aho M, Hilvo M, Vihervaara T, Kauhanen D, et al. Plasma ceramides predict cardiovascular death in patients with stable coronary artery disease and acute coronary syndromes beyond LDL-cholesterol. European heart journal. 2016;37(25):1967-76.
Liu H, Chen X, Hu X, Niu H, Tian R, Wang H, et al. Alterations in the gut microbiome and metabolism with coronary artery disease severity. Microbiome. 2019;7(1):68.
Randerath W, Bonsignore MR, Herkenrath S. Obstructive sleep apnoea in acute coronary syndrome. European respiratory review : an official journal of the European Respiratory Society. 2019;28(153).
Katira A, Katira R. Colchicine in coronary artery disease. Postgraduate medical journal. 2022;98(1163):718-21.
Kuneman JH, van Rosendael SE, van der Bijl P, van Rosendael AR, Kitslaar PH, Reiber JHC, et al. Pericoronary Adipose Tissue Attenuation in Patients With Acute Coronary Syndrome Versus Stable Coronary Artery Disease. Circulation Cardiovascular imaging. 2023;16(2):e014672.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Sami Ullah, Fazl I Subhan, Muhammad Shahab Ud Din Khalil, Irfan Ali Khan, Aamir Sohail, Arshad Ali
This work is licensed under a Creative Commons Attribution 4.0 International License.
