Kobayashi Akihiro, Misumida Naoki, Aoi Shunsuke, Kanei Yumiko
Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY, USA.
Department of Cardiology, Mount Sinai Beth Israel, New York, NY, USA.
Ann Noninvasive Electrocardiol. 2017 Nov;22(6). doi: 10.1111/anec.12442. Epub 2017 Feb 16.
Positive T wave in lead aVR has been shown to predict an adverse in-hospital outcome in patients with anterior wall ST-segment elevation myocardial infarction (STEMI). However, the prognostic value of positive T wave in lead aVR on a long-term outcome has not been fully explored.
We performed a retrospective analysis of 190 consecutive patients with first anterior wall STEMI who underwent an emergent coronary angiogram. Patients were divided into those with positive T wave > 0 mV and those with negative T wave ≦ 0 mV in lead aVR. Baseline and angiographic characteristics, and in-hospital revascularization procedures were recorded. In addition, in-hospital and 1-year major adverse cardiac events (MACE) including death, recurrent myocardial infarction, and target vessel revascularization were recorded.
Among 190 patients, 37 patients (19%) had positive T wave and 153 patients (81%) had negative T wave in lead aVR. Patients with positive T wave had higher rate of left main disease defined as stenosis ≥50% (11% vs. 2%, p = .028) than those with negative T wave. Patients with positive T wave had higher rate of 1-year MACE (38% vs. 13%, p < .001) driven by higher all-cause mortality (27% vs. 5%, p < .001). Positive T wave was an independent predictor for 1-year MACE (OR 2.74; 95% CI 1.04-7.15; p = .04).
Positive T wave in lead aVR was an independent predictor for 1-year MACE in patients with first anterior wall STEMI.
已证实，前壁ST段抬高型心肌梗死（STEMI）患者aVR导联T波直立可预测不良院内结局。然而，aVR导联T波直立对长期结局的预后价值尚未得到充分研究。
我们对190例连续接受急诊冠状动脉造影的首次前壁STEMI患者进行了回顾性分析。根据aVR导联T波＞0mV和T波≤0mV将患者分为两组。记录基线和血管造影特征以及院内血运重建程序。此外，记录院内和1年主要不良心血管事件（MACE），包括死亡、再发心肌梗死和靶血管血运重建。
190例患者中，37例（19%）aVR导联T波直立，153例（81%）aVR导联T波倒置。aVR导联T波直立的患者左主干病变（定义为狭窄≥50%）发生率高于T波倒置的患者（11%对2%，p = 0.028）。aVR导联T波直立的患者1年MACE发生率更高（38%对13%，p < 0.001），这是由更高的全因死亡率驱动的（27%对5%，p < 0.001）。T波直立是1年MACE的独立预测因素（OR 2.74；95%CI 1.04 - 7.15；p = 0.04）。
aVR导联T波直立是首次前壁STEMI患者1年MACE的独立预测因素。
