Yan Andrew T, Yan Raymond T, Kennelly Brian M, Anderson Frederick A, Budaj Andrzej, López-Sendón José, Brieger David, Allegrone Jeanna, Steg Gabriel, Goodman Shaun G
Division of Cardiology, St. Michael's Hospital, University of Toronto, and Canadian Heart Research Centre, Toronto, Ontario, Canada.
Am Heart J. 2007 Jul;154(1):71-8. doi: 10.1016/j.ahj.2007.03.037.
Limited data suggest that ST elevation (ST elevation) in aVR is associated with higher mortality and more extensive coronary artery disease in the setting of non-ST elevation acute coronary syndromes (ACS).
In the prospective Global Registry of Acute Coronary Events (GRACE) electrocardiographic substudy, the admission electrocardiograms were analyzed by a blinded core laboratory. We performed multivariable analysis to determine (1) the independent prognostic significance of ST elevation in aVR and (2) its association with significant (> or = 50% stenosis) left main or 3-vessel disease (LM/3-vd).
Among 5064 patients with non-ST elevation ACS, 4696 had no ST elevation in aVR, 292 (5.8%) had minor (0.5-1 mm) ST elevation in aVR, and 76 (1.5%) had major (>1 mm) ST elevation in aVR; their in-hospital mortality rates were 4.2%, 6.2%, and 7.9%, respectively (P for trend =.03). At 6 months follow-up, the cumulative mortality rates were 7.6%, 12.7%, and 18.3%, respectively (log-rank P for trend <.001). However, minor and major ST elevation in aVR were not independent predictors of in-hospital or 6-month death after adjusting for other validated prognosticators in the GRACE risk model. Of the 2416 patients without prior coronary bypass surgery who underwent cardiac catheterization, the prevalence of LM/3-vd was 26.1%, 36.2%, and 55.9% for the groups with no, minor, and major ST elevation in aVR, respectively (P for trend <.001). After adjusting for other clinical characteristics, major ST elevation in aVR remained an independent predictor of LM/3-vd (adjusted odds ratio, 2.68; 95% confidence interval, 1.29-5.58; P = .008).
ST elevation in aVR is less prevalent than reported in previous smaller studies. Although it is associated with higher unadjusted in-hospital and 6-month mortality, it does not provide incremental prognostic value beyond comprehensive risk stratification using the validated GRACE risk model. However, ST elevation greater than 1 mm in aVR may be useful in the early identification of LM/3-vd in ACS patients with ST depression.
有限的数据表明，在非ST段抬高型急性冠状动脉综合征（ACS）中，aVR导联的ST段抬高与更高的死亡率及更广泛的冠状动脉疾病相关。
在前瞻性全球急性冠状动脉事件注册研究（GRACE）的心电图子研究中，由一个盲法核心实验室对入院心电图进行分析。我们进行多变量分析以确定：（1）aVR导联ST段抬高的独立预后意义；（2）其与显著（≥50%狭窄）左主干或三支血管病变（LM/3-vd）的关联。
在5064例非ST段抬高型ACS患者中，4696例aVR导联无ST段抬高，292例（5.8%）aVR导联有轻度（0.5 - 1毫米）ST段抬高，76例（1.5%）aVR导联有重度（>1毫米）ST段抬高；他们的院内死亡率分别为4.2%、6.2%和7.9%（趋势P值 = 0.03）。在6个月随访时，累积死亡率分别为7.6%、12.7%和18.3%（趋势的对数秩检验P值 < 0.001）。然而，在GRACE风险模型中，校正其他已验证的预后因素后，aVR导联的轻度和重度ST段抬高并非院内或6个月死亡的独立预测因素。在2416例未行冠状动脉搭桥手术且接受心导管检查的患者中，aVR导联无ST段抬高、轻度ST段抬高和重度ST段抬高组的LM/3-vd患病率分别为26.1%、36.2%和55.9%（趋势P值 < 0.001）。校正其他临床特征后，aVR导联的重度ST段抬高仍是LM/3-vd的独立预测因素（校正比值比为2.68；95%置信区间为1.29 - 5.58；P = 0.008）。
aVR导联的ST段抬高比之前较小规模研究所报道的更为少见。尽管它与未经校正的较高院内及6个月死亡率相关，但在使用已验证的GRACE风险模型进行全面风险分层之外，它并未提供额外的预后价值。然而，aVR导联大于1毫米的ST段抬高可能有助于早期识别ST段压低的ACS患者中的LM/3-vd。
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