Banna Soumya, Schenck Christopher, Kim Noah, Ali Tariq, Gilmore Emily J, Greer David M, Beekman Rachel, Miller P Elliott
Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Eur Heart J Acute Cardiovasc Care. 2025 Apr 26;14(4):232-236. doi: 10.1093/ehjacc/zuaf018.
In acute coronary syndrome, ST-segment elevation in lead aVR (STE-aVR) indicates global myocardial ischaemia, often related to multivessel or severe left main disease, and correlates with increased mortality. The prevalence and prognostic significance of STE-aVR in cardiac arrest (CA) patients is unknown.
We identified patients (≥18 years) with CA between 2011 and 2022 who achieved return of spontaneous circulation (ROSC). The first electrocardiogram post-ROSC was assessed for STE-aVR, defined as ≥1 mm ST-segment elevation at the J point, measured by two trained assessors. Multivariable logistic regression was used to analyse the association between STE-aVR and outcomes (in-hospital mortality and poor neurologic outcome), adjusted for patient and arrest characteristics. Including 443 CA patients, the median (interquartile range) age was 61 years (50-72 years), with 60.5% (n = 268) male, 65.7% (n = 291) presenting with out-of-hospital CA (OHCA), and 29.8% (n = 132) with shockable rhythms. ST-segment elevation in lead aVR was observed in 18.3% (n = 81) of patients. Those with STE-aVR were more likely to present with OHCA and less likely to have a shockable rhythm (both, P < 0.05). ST-segment elevation in lead aVR was associated with higher in-hospital mortality (86.4% vs. 65.8%, P < 0.001) and poor neurologic outcomes (90.1% vs. 72.9%, P = 0.001). After multivariable adjustment, STE-aVR remained associated with higher in-hospital mortality [odds ratio (OR) 2.23; 95% confidence interval (CI): 1.02-4.84, P = 0.04], but not a poor neurologic outcome (OR 2.12; 95% CI: 0.90-4.98, P = 0.09).
ST-segment elevation in lead aVR was present in one in five CA survivors and was independently associated with higher in-hospital mortality.
在急性冠状动脉综合征中，aVR导联ST段抬高（STE-aVR）提示全心肌缺血，常与多支血管病变或严重左主干病变相关，且与死亡率增加相关。STE-aVR在心脏骤停（CA）患者中的发生率及预后意义尚不清楚。
我们纳入了2011年至2022年间发生CA且实现自主循环恢复（ROSC）的患者（≥18岁）。由两名经过培训的评估人员对ROSC后的第一份心电图进行评估，以确定是否存在STE-aVR，定义为J点ST段抬高≥1 mm。采用多变量logistic回归分析STE-aVR与结局（院内死亡率和不良神经学结局）之间的关联，并对患者和心脏骤停特征进行校正。纳入443例CA患者，年龄中位数（四分位间距）为61岁（50-72岁），男性占60.5%（n = 268），65.7%（n = 291）为院外心脏骤停（OHCA），29.8%（n = 132）为可除颤心律。18.3%（n = 81）的患者出现aVR导联ST段抬高。STE-aVR患者更可能为OHCA，且发生可除颤心律的可能性较小（均P < 0.05）。aVR导联ST段抬高与更高的院内死亡率（86.4%对65.8%，P < 0.001）和不良神经学结局（90.1%对72.9%，P = 0.001）相关。多变量校正后，STE-aVR仍与更高的院内死亡率相关[比值比（OR）2.23；95%置信区间（CI）：1.02-4.84，P = 0.04]，但与不良神经学结局无关（OR 2.12；95%CI：0.90-4.98，P = 0.09）。
五分之一的CA存活者存在aVR导联ST段抬高，且与更高的院内死亡率独立相关。
