ST Segment Elevation in Lead aVR: Clinical Significance in Acute Coronary Syndrome

Objective: We sought to determine the electrocardiographic (ECG) features associated with acute left main coronary artery (LMCA) obstruction. Study Design: Descriptive observational study. Place and duration: The study was conducted at Faisalabad Institute of Cardiology Faisalabad from August 2015 to March 2016. Materials and Methods: Total 70 consecutive patients of age≥ 30 years, of any gender who fulfills the inclusion and exclusion criteria were enrolled in the study. We enrolled 70 patients who presented in the emergency department of Faisalabad Institute of cardiology, Faisalabad with non- ST elevation acute coronary syndrome. Demographic characteristics of all patients were obtained. A 12 leads ECG of all patients were done to observe any ST segment elevation or depression especially ST elevation in lead aVR. H/O risk factors for CAD like hypertension, diabetes mellitus, family H/O ischemic heart disease and hyperlipidemia was noted. Results: Total 70 patients were enrolled in the study. 52 (74.3%) were male and 18(25.7%) were female. Mean age was 55.94±7.44 years. Troponin-I (Trop-I) was positive in 45(64.3%) patients. Hyperlipidemia was documented in 40(57.1%), 37(52.9%) were smokers, 31(44.3%) were hypertensive and 32(45.7%) were diabetics. Significant LMCA stenosis was found in 52(74.3%) and out of this 39(75%) were male and 13(72.22%) were female. 52(74.2) patients with ACS had significant LMS disease. 37 (82.8%) patients with positive Trop. I had significant LMS disease. Significant LMS disease was observed in 26(81.25%) diabetics. Conclusion: ST-segment elevation ≥ 0.5mm in aVR lead of ECG identifies significant LMCA stenosis in patients presenting with ACS, especially in male, elderly and with raised cardiac markers. It also contributes to predict patient’s clinical outcome.