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Abstract
Risk assessment (on admission) is extremely valuable for patients with NSTEMI, for management strategy and optimization of resources.
ECG is a very easy, rapid and applicable way of risk assessment and is of great value especially in developing countries with low resources.
So, this study was designed for fulfilling the purpose of an easy way of risk assessment for ischemic patients for better case management.
The objectives of the study were:
1. Exploring the potentials of ST-segment elevation in lead aVR as a prognostic sign for a worse ischemic condition and worse outcome.
2. Correlation of this ECG criterion with the results of coronary angiography.
The study consisted of 60 patients that were classified into two groups according to the elevation of ST-segment in lead aVR; no or < 0.05 mV elevation and ? 0.05 mV.
Patients must have had chest pain for more than 20 minutes with a significant rise in cardiac enzymes to be considered in these groups.
All patients who had ST-segment elevation in leads other than aVR and V1, LBBB, previous ST-segment elevation myocardial infarction, previous CABG or with pacemaker were excluded.
All patients had the following: medical history taken, clinical examination, admission ECG, cardiac enzymes level measured, recording of the clinical complications and hospital outcome, echocardiography and coronary angiography done within 1 month.
In this study, it was found that:
Higher age groups, male gender, diabetes mellitus, previous angina and previous PCI were found in the aVR group while hypertension, smoking, and positive family history were higher in the other group
Changes in ECG that are well-known to be of ischemic cause were closely associated more with elevation of ST-segment in aVR, especially the number of contiguous leads showing ST-segment depression, very significant statistical relationship.
Patients with ST-segment elevation in lead aVR had lower ejection fraction and higher wall motion abnormality score index.
In-hospital complications in the form of prolonged repeated anginal attacks, heart failure, re-infarction and death were collectively higher in aVR group with high statistical significance for both recurrent angina and heart failure, but insignificant for death and re-infarction.
And as a final and visual proof, angiographic survey in this study showed more angiographic lesions to be highly associated with the aVR group, and more complex and critical lesions too, which again favors the early invasive approach, with a good positive correlation between the number of angiographic lesions and the elevation of ST-segment in lead aVR.
No other ECG changes that are known to be of ischemic cause could keep the competition with all these advantages and positive correlations, the number of leads with ST depression had no statistical correlation with angiographic lesions numbers.
All these findings illuminated the path for new, previously neglected, easily applied and very sensitive ECG prognostic criteria.