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aVR ST elevation: an important but neglected sign in ST elevation acute myocardial infarction

Wong, C. K. et al.

European heart journal. VOL 31; NUMBER 15, ; 2010, 1845-1853 -- Oxford University Press (pages 1845-1853) -- 2010

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  • Title:
    aVR ST elevation: an important but neglected sign in ST elevation acute myocardial infarction
  • Author: Wong, C. K.;
    Gao, W.;
    Stewart, R. A.;
    Benatar, J.;
    French, J. K.;
    Aylward, P. E.;
    White, H. D.
  • Found In: European heart journal. VOL 31; NUMBER 15, ; 2010, 1845-1853
  • Journal Title: European heart journal.
  • Subjects: Medicine; Biotechnology; Pharmaceutical Chemistry; LCC: RC; Dewey: 616.12
  • Publication Details: Oxford University Press
  • Language: English
  • Abstract: Aim This study evaluated the prognostic implications of aVR ST elevation during ST elevation acute myocardial infarction (AMI). Methods and results The Hirulog and Early Reperfusion/Occlusion-2 study randomized 17 073 patients with acute ST elevation AMI within 6 h of symptom onset to receive either bivalirudin or heparin, in addition to streptokinase and aspirin. The treatments had no effect on the primary endpoint of 30-day mortality. Electrocardiographic recordings were performed at randomization and at 60 min after commencing streptokinase. aVR ST elevation ≥1 mm was associated with higher 30-day mortality in 15 315 patients with normal intraventricular conduction regardless of AMI location (14.7% vs. 11.2% for anterior AMI, P = 0.0045 and 16.0% vs. 6.4% for inferior AMI, P < 0.0001). After adjusting for summed ST elevation and ST depression in other leads, associations with higher mortality were found with aVR ST elevation of ≥1.5 mm for anterior [odds ratio 1.69 (95% CI 1.16 to 2.45)] and of ≥1 mm for inferior AMI [odds ratio 2.41 (95% CI 1.76 to 3.30)]. There was a significant interaction between aVR ST elevation and infarct location. Thirty-day mortality was similar with anterior and inferior AMI when aVR ST elevation was present (11.5% vs. 13.2%, respectively, P = 0.51 with 1 mm and 23.5% vs. 22.5% respectively, P = 0.84 with ≥ 1.5 mm ST elevation). After fibrinolytic therapy, resolution of ST elevation in aVR to <1 mm was associated with lower mortality, while new ST elevation ≥1 mm was associated with higher mortality. Conclusion aVR ST elevation is an important adverse prognostic sign in AMI.
  • Identifier: Journal ISSN: 0195-668X
  • Publication Date: 2010
  • Physical Description: Electronic
  • Shelfmark(s): 3829.717500
  • UIN: ETOCRN280801420

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