Amirpour Afshin, Masoumi Hosein, Sadeghi Masoumeh, Zavar Reihaneh, Darouei Bahar, Mirbod Seyedeh Mahnaz, Amani-Beni Raza
Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
ARYA Atheroscler. 2024;20(5):25-37. doi: 10.48305/arya.2024.42601.2954.
In this study, we aimed to investigate the prognostic implications of lead aVR ST-segment elevation in an initial electrocardiogram (ECG) in patients diagnosed with acute coronary syndrome (ACS). Furthermore, we evaluated the association between electrocardiographic changes in lead aVR and objective measures such as angiographic findings and Syntax score.
This retrospective cohort study, conducted as a pilot study, encompassing both a retrospective cross-sectional analysis and a longitudinal follow-up, took place at Chamran Hospital from November 2017 to October 2019. A 6-month follow-up was conducted via phone interviews to assess patient outcomes.
During the study period, there were 76 admissions with the final diagnosis of acute coronary syndrome and lead aVR ST-segment elevation on ECG. ARB intake and the severity of right coronary artery stenosis were significantly higher in patients with STE-aVR ≥1.5 mm. The clinical pathway analysis and 6-month follow-up outcomes concerning ST-segment changes in lead aVR did not reveal statistically significant differences in the distribution of various intervention strategies and clinical events. The overall ST-change was a significant risk factor for 6-month follow-up angiography (OR: 1.10; 95% CI: 1.002 to 1.213) and was also significantly associated with any stenosis in the RCA territory (OR: 1.10; 95% CI: 1.004 to 1.21). There was no significant association between ST-change and other follow-up hospital and angiography outcomes.
The findings suggest that medication history, particularly with angiotensin receptor blockers, may shape the observed ST-segment changes in lead aVR. However, further investigation is needed to better understand the clinical implications of these trends.
在本研究中，我们旨在探讨急性冠状动脉综合征（ACS）患者初始心电图（ECG）中aVR导联ST段抬高的预后意义。此外，我们评估了aVR导联心电图变化与血管造影结果和Syntax评分等客观指标之间的关联。
这项回顾性队列研究作为一项试点研究进行，包括回顾性横断面分析和纵向随访，于2017年11月至2019年10月在Chamran医院开展。通过电话访谈进行为期6个月的随访，以评估患者的预后。
在研究期间，共有76例最终诊断为急性冠状动脉综合征且心电图显示aVR导联ST段抬高的患者入院。STE-aVR≥1.5 mm的患者中，ARB的使用情况和右冠状动脉狭窄的严重程度显著更高。关于aVR导联ST段变化的临床路径分析和6个月随访结果显示，各种干预策略和临床事件的分布在统计学上没有显著差异。总体ST段变化是6个月随访血管造影的显著危险因素（OR：1.10；95%CI：1.002至1.213），并且也与RCA区域的任何狭窄显著相关（OR：1.10；95%CI：1.004至1.21）。ST段变化与其他随访医院和血管造影结果之间没有显著关联。
研究结果表明，用药史，特别是使用血管紧张素受体阻滞剂，可能会影响观察到的aVR导联ST段变化。然而，需要进一步研究以更好地理解这些趋势的临床意义。
