1. Short- and long-term prognostic significance of ST-segment elevation in lead aVR in patients with non-ST-segment elevation acute coronary syndrome
- Author
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Paolo Ortolani, Laura Cinti, Giuseppe Scaramuzzino, Tullio Palmerini, Cinzia Marrozzini, Antonio Marzocchi, Claudio Rapezzi, Ilaria Gallelli, Laura Alessi, Francesco Saia, Caterina Villani, Giovanni Melandri, Angelo Branzi, Fabio Vagnarelli, Nevio Taglieri, Stefania Rosmini, Taglieri N., Marzocchi A., Saia F., Marrozzini C., Palmerini T., Ortolani P., Cinti L., Rosmini S., Vagnarelli F., Alessi L., Villani C., Scaramuzzino G., Gallelli I., Melandri G., Branzi A., and Rapezzi C.
- Subjects
Male ,medicine.medical_specialty ,Acute coronary syndrome ,Time Factors ,ELECTROCARDIOGRAM ,Coronary Angiography ,Culprit ,Severity of Illness Index ,NO ,Diagnosis, Differential ,Electrocardiography ,Internal medicine ,Cause of Death ,medicine ,ST segment ,Humans ,Hospital Mortality ,Acute Coronary Syndrome ,Aged ,Retrospective Studies ,ST depression ,medicine.diagnostic_test ,business.industry ,ST elevation ,ACUTE CORONARY SYNDROMES ,CARDIOVASCULAR RISK ,Hazard ratio ,non ST segment elevation ,Odds ratio ,Middle Aged ,medicine.disease ,Prognosis ,Survival Rate ,Early Diagnosis ,Italy ,Cardiology ,Disease Progression ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
We sought to evaluate the prognostic significance of ST-segment elevation (STE) in lead aVR in unselected patients with non-STE acute coronary syndrome (NSTE-ACS). We enrolled 1,042 consecutive patients with NSTE-ACS. Patients were divided into 5 groups according to the following electrocardiographic (ECG) patterns on admission: (1) normal electrocardiogram or no significant ST-T changes, (2) inverted T waves, (3) isolated ST deviation (ST depression [STD] without STE in lead aVR or transient STE), (4) STD plus STE in lead aVR, and (5) ECG confounders (pacing, right or left bundle branch block). The main angiographic end point was left main coronary artery (LM) disease as the culprit artery. Clinical end points were in-hospital and 1-year cardiovascular death defined as the composite of cardiac death, fatal stroke, and fatal bleeding. Prevalence of STD plus STE in lead aVR was 13.4%. Rates of culprit LM disease and in-hospital cardiovascular death were 8.1% and 3.8%, respectively. On multivariable analysis, patients with STD plus STE in lead aVR (group 4) showed an increased risk of culprit LM disease (odds ratio 4.72, 95% confidence interval [CI] 2.31 to 9.64, p
- Published
- 2011