Abstract
Background
Identification of ST elevation myocardial infarction (STEMI) is critical because early
reperfusion can save myocardium and increase survival. ST elevation (STE) in lead
augmented vector right (aVR), coexistent with multilead ST depression, was endorsed
as a sign of acute occlusion of the left main or proximal left anterior descending
coronary artery in the 2013 STEMI guidelines. We investigated the incidence of an
acutely occluded coronary in patients presenting with STE-aVR with multilead ST depression.
Methods
STEMI activations between January 2014 and April 2018 at the University of Arizona
Medical Center were identified. All electrocardiograms (ECGs) and coronary angiograms
were blindly analyzed by experienced cardiologists. Among 847 STEMI activations, 99
patients (12%) were identified with STE-aVR with multilead ST depression.
Results
Emergent angiography was performed in 80% (79/99) of patients. Thirty-six patients
(36%) presented with cardiac arrest, and 78% (28/36) underwent emergent angiography.
Coronary occlusion, thought to be culprit, was identified in only 8 patients (10%),
and none of those lesions were left main or left anterior descending occlusions. A
total of 47 patients (59%) were found to have severe coronary disease, but most had
intact distal flow. Thirty-two patients (40%) had mild to moderate or no significant
disease. However, STE-aVR with multilead ST depression was associated with 31% in-hospital
mortality compared with only 6.2% in a subgroup of 190 patients with STEMI without
STE-aVR (p<0.00001).
Conclusions
STE-aVR with multilead ST depression was associated with acutely thrombotic coronary
occlusion in only 10% of patients. Routine STEMI activation in STE-aVR for emergent
revascularization is not warranted, although urgent, rather than emergent, catheterization
appears to be important.
Keywords
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Article Info
Publication History
Published online: January 09, 2019
Footnotes
Funding: None.
Conflicts of interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
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© 2019 Elsevier Inc. All rights reserved.