scholarly journals Clinical Significance of ST Segment Depression in Lead aVR to Predict Culprit Artery in An Acute Inferior Wall Myocardial Infarction

2015 ◽  
Vol 12 (1) ◽  
pp. 5-9 ◽  
Author(s):  
Madhu Gupta ◽  
Maheswar Prasad Kurmi ◽  
Bhoj Raj Sharma ◽  
Liping Chen ◽  
Ravi Shahi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Inferior Wall ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
St Segment ◽  
Lead Avr ◽  
St Elevation

Background and Aims: The main objective of this study is to analyze between left circumflex artery and right coronary artery as a presumptive predictor of a culprit artery in patients with an acute inferior wall ST elevation myocardial infarction according to ST segment change in lead aVR. Methods: This study included 145 consecutive patients who presented with an inferior wall ST elevation myocardial infarction and underwent coronary angiography. Clinical and angiographic findings were compared between patients with and without aVR depression ≥ 0. 1mV. Results: The sensitivity and specificity of ST segment depression in lead aVR to predict left circumflex artery as the culprit artery were 69% and 85%, respectively, and the positive predictive value and negative predictive value to predict left circumflex artery as the culprit arteries were 66% and 87%, respectively. Conclusion: Our study supports, the presence of ST segment depression in lead aVR is associated with good specificity and negative predictive value and modest sensitivity and positive predictive value to determine left circumflex artery as an infarct related artery in an acute ST segment elevation inferior wall myocardial infarction.DOI: http://dx.doi.org/10.3126/njh.v12i1.12324 Nepalese Heart Journal Vol.12(1) 2015: 5-9  

scholarly journals A Study of the ST Changes in the aVR Lead on 12-Lead ECG to Identify Infarct - Related Artery (IRA) in Patients With Acute Inferior Wall Myocardial Infarction

2021 ◽  
Vol 2 (2) ◽  
pp. 44-49
Author(s):  
Aditya Mahaseth ◽  
Bikas Nepal ◽  
Biplave Karki ◽  
Jeet Ghimire ◽  
Naveen Pandey ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Clinical Symptoms ◽  
Inferior Wall ◽  
Cross Sectional ◽  
St Depression ◽  
St Segment ◽  
Lead Avr ◽  
The Right

BACKGROUND:  Lead avR is a valuable but mostly ignored lead in clinical electrocardiography. Recently, ST-segment depression in lead aVR during an inferior wall myocardial infarction has been suggested as a predictor of LCX artery involvement. METHODS: This study was a single centre cross sectional observational study done in BPKIHS, Dharan from February 2018 to January 2020. Patients presenting to the OPD or emergency room of BPKIHS diagnosed as acute inferior wall myocardial infarction based on clinical symptoms, ECG and/or Cardiac tropinin I levels, and planned for coronary angiography, meeting the inclusion and exclusion criterias were included. RESULTS: Among 134 cases, male:female ratio was 1.3:1. Overall, 38 patients (28.4%) were found to have aVR depression and 96 patients (71.6%) were without aVR depression. The culprit artery was found to be the right coronary artery in 95 patients (70.9%), the LCx in 39 patients (29.1%). The sensitivity and specificity of ST-segment depression in lead aVR for LCx as the culprit artery were 92.3% and 97.9% respectively. Positive predictive and Negative predictive value for LCx as the culprit arteries were 94.74% and 96.87%. The sensitivity, specificity, positive predictive value and negative predictive value for RCA as the culprit artery were 97.89%, 92.3%, 96.89% and 94.73% respectively. CONCLUSION: Significant ST depression in aVR is associated with a higher specificity and good sensitivity for LCX lesions, the ST changes in this lead should be carefully examined in all patients who are suspected of having inferior wall myocardial infarction.

scholarly journals A case of left circumflex artery stenosis involving ST segment depression in multiple leads with ST elevation in lead augmented vector right

2019 ◽  
Vol 6 (7) ◽  
pp. 2598
Author(s):  
C. P. Karunadas ◽  
Cibu Mathew
Keyword(s):  
Beta Blockers ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Circumflex Artery ◽  
St Segment Elevation ◽  
Left Circumflex Artery ◽  
St Depression ◽  
St Segment ◽  
Lead Avr ◽  
St Elevation

Electrocardiography (ECG) patterns of ST-segment elevation in lead aVR with or without diffuse ST segment depression may predict either left main coronary artery or triple vessel stenosis. Here, we have presented the case of a 56-year-old female involving such an ECG pattern with ST-segment depression in more than eight leads and ST Segment elevation in lead aVR, however, showing stenosis of the mid-segment of the left circumflex artery (LCX). She was scheduled to undergo percutaneous coronary intervention with implantation of a drug-eluting stent with respect to mid LCX stenosis. The patient was asymptomatic post procedure and was discharged on beta blockers. To conclude, the ECG pattern of ST depression in multiple leads with ST-elevation in aVR lead can occur in LCX obstruction as well. 

scholarly journals Electrocardiographic localization of infarct related coronary artery in acute inferior wall ST elevation myocardial infraction and in hospital outcome in tertiary cardiac care center

2018 ◽  
Vol 15 (1) ◽  
pp. 23-27
Author(s):  
Rajaram Khanal ◽  
Arun Sayami ◽  
Ratnamani Gajurel ◽  
Hemanta Shrestha ◽  
Sanjeev Thapa ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Hospital Mortality ◽  
Care Center ◽  
Inferior Wall ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
St Segment ◽  
Myocardial Infraction ◽  
Infarct Related Artery ◽  
St Elevation

Background: In addition to diagnosing the acute ST Elevation MI stratifying (STEMI) high-risk patients and proper treatment strategies are important issues in managing patients. The goal of this study was to determine the relation of ST segment changes in Electrocardigram with the site of occlusion in vessel , to evaluate the prognostic value of ST segment deviation in aVR and its role in identification of Infarct Related Artery (IRA) in patients with acute inferior myocardial infarction.Methods: The study included 56 patients with acute inferior wall STEMI. All patients underwent Coronary Angiogram. Patients were divided into two groups based on the IRA and were followed up during their hospital stay for complications.Result: The culprit artery was Right Coronary Artery (RCA) in 40 patients (71.4%) and Left Circumflex Artery (LCX) in 13 patients (23.2%). Study showed 92% sensitivity, 80% specificity for predicting RCA related infarction with ST elevation lead III > lead II and 83% sensitivity ,90% specificity for (LCX) with ST elevation lead II > lead III . The overall in-hospital mortality was 3.5%.ST depression in aVR was associated with 87.5% specificity and 83% sensitivity in diagnosing LCX as the Infarct Related Artery (IRA). The in-hospital mortality rates for patients with ST segment deviation in aVR (20 patients) and no ST segment changes (36 patients) were 5% and 2.7% respectively.Conclusion: In addition to the conventional ECG criteria for identifying culprit vessel, lead aVR may be useful in clinical practice when assessing patients with inferior STEMI and with poor in-hospital outcome.Nepalese Heart Journal 2018; 15(1): 23-27

scholarly journals Comparison of clinical outcome in acute inferior wall myocardial infarction based on culprit artery: right coronary artery vs left circumflex artery

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
F Altarejos ◽  
C Barea ◽  
BG Hernandez-Meneses ◽  
R Hidalgo-Urbano ◽  
M Almendro-Delia ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Clinical Outcome ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Hospital Stay ◽  
Inferior Wall ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
St Elevation

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Acute inferior wall myocardial infarction (AIWMI) is related to Right Coronary Artery (RCA) occlusion in about 80% of cases and to Left Circumflex Artery (LCX) in the rest of them, in most series. However it has not been established yet if there is a difference in prognosis depending on culprit artery. PURPOSE This study compares clinical outcome during hospital stay between RCA-related and LCX-related AIWMI. METHODS We analysed all patients with AIWMI admitted to the Cardiac Care Unit between August 2011 and February 2019, both ST-elevation (STEMI) and non ST-elevation myocardial infarction, and whose culprit artery was either the RCA or the LCX. Basal characteristics and clinical outcome during hospital stay were compared between RCA and LCX. RESULTS Among 2252 patients with acute coronary syndrome, 650 were AIWMI. Among them, the culprit artery was the RCA in 461, the LCX in 149, and other or not defined in 30. The mean age was 61.7 ± 11.6 years, 79% of them were male and 21% female. They had a history of current smoking in 50.7%, diabetes mellitus in 24.4%, hypertension in 52.1%, dyslipemia in 44.3% and obesity in 28.7%, without differences between RCA and LCX. RCA patients presented as STEMI in 93.3% vs 87.2% of LCX patients (p = 0.025). Among those presenting as STEMI, 84.4% of RCA and 90.8% of LCX underwent primary coronary intervention. Mean ejection fraction was 50.8% in RCA and 51.2% in LCX. Three-vessel or left main disease was present in 10.2% of RCA and 10.8% of LCX. There was atrioventricular block in 17.8% of RCA and 3.4% of LCX (p < 0.001); atrial fibrillation in 10.2% of RCA and 11.4% of LCX, ventricular fibrillation in 10.4% of RCA and 7.4% of LCX. Median of peak CPK was 1203 in RCA, vs 1785 in LCX (p < 0.001). There was cardiogenic shock (CS) at admission in 5.4% of RCA vs 1.3% of LCX, (p = 0.038) and CS whenever the hospital stay in 8.4% vs 4.0% (p = 0.072). In-hospital mortality was 3.3% in RCA and 3.4% in LCX. Several models of multivariate logistic regression analysis did not find a predictive value of the culprit artery in the development of CS or in-hospital mortality. CONCLUSION AIWMI related to LCX have greater enzymatic size than those related to RCA. However, RCA infarctions present more often atrioventricular block and cardiogenic shock at admission. Multivariate analysis did not shock significant differences in the development of CS or in-hospital mortality. Abstract Figure. Peak CPK depending on culprit artery

scholarly journals Isolated ST-Elevation Myocardial Infarction Involving Leads I and aVL: Angiographic and Electrocardiographic Correlations from a Tertiary Care Center

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Abhishek Singh ◽  
Sudhanshu Dwivedi ◽  
Akshyaya Pradhan ◽  
Varun S Narain ◽  
Rishi Sethi ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Tertiary Care ◽  
Coronary Angiogram ◽  
Coronary Syndrome ◽  
St Depression ◽  
St Segment ◽  
Infarct Related Artery ◽  
St Elevation

Background. Determining the infarct-related artery in STEMI during a coronary angiogram can be challenging due to the affliction of multiple vessels. Isolated STEMI involving only EKG leads I and aVL is infrequent. Localization of infarct-related artery based on EKG findings has not been previously done in this subset. Methods. All consecutive de novo acute coronary syndrome (ACS) patients admitted to coronary care unit with ST elevations involving only leads I and aVL were screened for enrollment. Patients with ST elevation in any additional lead and those who refused a coronary angiogram were excluded. Subsequently, a coronary angiogram was done as part of primary PCI or a pharmacoinvasive approach to identify the infract-related artery (IRA). IRA was defined by characteristics of lesion, flow of blood through stenosis, and presence of intracoronary thrombus. Coronary angiogram was interpreted by two independent observers blinded to the EKG findings. ST changes in inferior and precordial leads were analyzed to find ECG predictors of the culprit artery. Results. A total of 54 eligible patients of ACS were included in the study. The first major diagonal (D1) was the most frequent IRA in 35.2% followed by left circumflex-obtuse marginal (LCX-OM11) in 29.6%, left anterior descending (LAD) in 20.4%, and ramus intermedius (RI) in 14.8%. Out of total patients with ST depression in lead V2, the LCX-OM11 group was IRA in 50% cases while the RI, D1, and LAD groups accounted for 31.8%, 13.6%, and 4.5%, respectively ( p < 0.001 ). Similarly, LCX-OM1 was the most frequent IRA subjects with ST depressions in leads V1 and V3 (44.4%; p = 0.010 and 46.2%; p = 0.003 , resp.). On the contrary, in patients with ST depression in lead III, LAD and D1 were the most frequent IRA as compared to LCX-OM1 and RI though statistical significance was not attained ( p = 0.857 for lead III). ST-segment depression in lead V2 had a positive predictive value of 60% and a negative predictive value of 100% for LCX-OM1 as IRA. Similarly, ST-segment depression in lead V2 had a positive predictive value of 20% and a negative predictive value of 100% for the RI group. Conclusions. In patients presenting with isolated ST elevation in leads I and aVL, the most frequent IRA on angiogram was first diagonal. ST depressions in EKG leads V1–V3 were the most common predictor of LCX–OM1 while those in inferior leads indicated LAD-D1 as the IRA.

scholarly journals Point of Care Tests VerifyNow P2Y12 and INNOVANCE PFA P2Y Compared to Light Transmittance Aggregometry After Fibrinolysis

2018 ◽  
Vol 24 (7) ◽  
pp. 1109-1116 ◽  
Author(s):  
Vincent Roule ◽  
Pierre Ardouin ◽  
Yohan Repessé ◽  
Agnès Le Querrec ◽  
Katrien Blanchart ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Platelet Reactivity ◽  
Point Of Care ◽  
Light Transmittance ◽  
Light Transmittance Aggregometry ◽  
St Elevation ◽  
Point Of Care Tests

Detection of high on-treatment platelet reactivity (HPR) by point-of-care tests has not been validated after successful fibrinolysis for ST-elevation myocardial infarction. We assessed the validity of the point-of-care VerifyNow P2Y12 (VN) and INNOVANCE PFA P2Y (PFA) tests on HPR compared to light transmittance aggregometry (LTA) in these patients. The HPR was identified in 10 (34.5%) patients, 15 (51.7%) patients, and 14 (50%) patients using LTA, VN, and PFA, respectively. Discrepancies were observed between the tests despite significant correlations between platelet reactivity measures by LTA and VN ( r = 0.74; P < .0001) and LTA and PFA ( r = .75; P < .0001). Compared to LTA, VN and PFA were associated with a 92% and 53% and 92% and 64% positive predictive value (PPV) and negative predictive value (NPV), respectively, in detecting HPR. When combined, VN and PFA results yielded 90% and 100% PPV and NPV values if discrepancies between the 2 tests were considered as non-HPR. The VN or PFA identify patients without HPR correctly but overestimate the proportion of HPR patients. The association of the 2 tests, in case of HPR, improves the accuracy of the detection of HPR.

scholarly journals ASSOCIATION OF ST ELEVATION IN LEAD AVR WITH LEFT MAIN STEM AND TRIPLE VESSEL DISEASES IN PATIENTS WITH NON-ST ELEVATION MYOCARDIAL INFARCTION

2022 ◽  
Vol 54 (4) ◽  
pp. 348-351
Author(s):  
Hafiz Tahir Usman ◽  
Kashif Ali Hashmi ◽  
Mohammad Sohail Saleemi ◽  
Ammar Akhtar
Keyword(s):  
Myocardial Infarction ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Main Stem ◽  
St Elevation Myocardial Infarction ◽  
Left Main ◽  
Left Main Stem ◽  
Lead Avr ◽  
St Elevation ◽  
Sensitivity Specificity

Objectives: To determine frequency of left main stem (LMS) and triple vessel coronary artery disease (3VCAD) in patients of Non-ST-elevation myocardial infarction (NSTEMI) and to compare the frequency of LMS and 3VCAD in patients with NSTEMI with or without ST elevation in lead aVR. Methodology: Total 346 patients with NSTEMI having age 30-70 years were included in this descriptive cross-sectional study. The data on demographic details was collected. All patients underwent electrocardiography (ECG) and cardiac specific troponin-I assessment. Patients were categorized as NSTEMI with or without ST-elevation in lead aVR. Coronary angiography was performed in all patients and angiographic findings were noted. Results: Mean age of patients was 51.87±10.03 years. There were 218 (63.01%) males and 128 (36.99%) female patients. 182 (52.60%) patients of NSTEMI had ST elevation in aVR. LMS disease was found in 53 (29.10%) patients with ST elevation in aVR. Sensitivity, specificity, positive predive value and negative predictive value of ST elevation in aVR for LMS disease was 62.35%, 50.57%, 29.12% and 80.49% respectively. 3 VCAD was found in 54 (29.70%) with ST elevation in aVR. Sensitivity, specificity, positive predive value and negative predictive value of ST elevation in aVR for 3VCAD was 77.14%, 53.52%, 29.67% and 90.24% respectively. Conclusion: NSTEMI patients with ST elevation in aVR may have higher chances of having LMS disease or 3VCAD. There is high negative predictive value for ST elevation in aVR to predict LMS disease or 3VCAD.

Sign in / Sign up

Export Citation Format

Share Document