Ahmed Salman, Khatti Shehzad, Shah Ghazanfar Ali, Khan Naveedullah, Rai Lajpat, Khan Mohammad Zeb, Bari Syed Abdul, Roy Naveen
National Institute of Cardiovascular Diseases, Tando Muhammad Khan.
NiCVD, Karachi.
J Ayub Med Coll Abbottabad. 2023 Feb-Mar;35(1):43-49. doi: 10.55519/JAMC-01-10590.
: Global ST depression in 8 or more leads along with ST elevation in aVR has been considered as hallmark of widespread sub-endocardial ischemia. It has been associated with left main (LM) stem or three vessel disease (3VD). But different studies have shown different results. We collected data from patients to see association of these ECG changes with significant LM stem disease and/or significant (3VD).
TIt was a prospective observational study performed at tertiary care cardiac center. All patients with acute coronary syndrome (ACS) having global ST depression and ST Elevation in aVR (that is ST depression of at least 0.5 mv in ≥8 leads along with ST elevation in aVR of at least 0.5 mv) and have undergone coronary angiogram were included.
Our study included 404 patients with above mentioned ECG findings. We observed significant LM stem or significant 3VD in 67% (n=274), 3VD in 55% (n=222) and significant LM stem in only 29% (n=118). Risk factors like diabetes, hypertension and smoking increase probability of these ECG changes up to 40.4%, 32.1% and 33.3% for significant LM stem disease and 62.7%, 57.1% and 57.5% for significant 3VD. Magnitude of ST elevation in aVR leads ≥1 mm increase sensitivity for LM stem disease 35% and for 3VD up to 60.4% and TIMI score ≥4 up to 36.7% for significant LM stem disease and 62.5% for significant 3VD.
: Global ST depression along with ST elevation in aVR in patients with ACS has low probability for significant LM stem intermediate probability for significant 3VD. Factors like presence of diabetes, hypertension, smoking, magnitude of ST elevation in aVR, and TIMI score improves its diagnostic yield.
8个或更多导联出现全球性ST段压低伴aVR导联ST段抬高被认为是广泛的心内膜下缺血的标志。它与左主干（LM）病变或三支血管病变（3VD）有关。但不同研究结果各异。我们收集患者数据以观察这些心电图改变与严重左主干病变和/或严重三支血管病变的关联。
这是在三级心脏护理中心进行的一项前瞻性观察研究。纳入所有患有急性冠状动脉综合征（ACS）且有全球性ST段压低及aVR导联ST段抬高（即≥8个导联ST段压低至少0.5 mV伴aVR导联ST段抬高至少0.5 mV）并已接受冠状动脉造影的患者。
我们的研究纳入了404例有上述心电图表现的患者。我们观察到67%（n = 274）有严重左主干病变或严重三支血管病变，55%（n = 222）有三支血管病变，仅29%（n = 118）有严重左主干病变。糖尿病、高血压和吸烟等危险因素使这些心电图改变的概率增加，严重左主干病变分别高达40.4%、32.1%和33.3%，严重三支血管病变分别为62.7%、57.1%和57.5%。aVR导联ST段抬高幅度≥1 mm使左主干病变的敏感性提高35%，三支血管病变提高至60.4%，对于严重左主干病变，TIMI评分≥4使敏感性提高36.7%，对于严重三支血管病变提高至62.5%。
ACS患者出现全球性ST段压低伴aVR导联ST段抬高时，严重左主干病变的概率较低，严重三支血管病变的概率中等。糖尿病、高血压、吸烟、aVR导联ST段抬高幅度和TIMI评分等因素可提高其诊断价值。
