Significance of Lead aVR ST Segment Elevation in Acute Coronary Syndrome Kriengkrai Hengrussamee, MD*, Wirash Kehasukcharoen, MD*, Sudaratana Tansuphaswadikul, MD*
* Cardiac Unit, Chest Disease Intitute, Nonthaburi
Affiliation : Objectives : To study the relation between lead aVR ST segment elevation (aVRSTE) and angiographic coro-
nary artery lesions in patients with acute coronary syndrome (ACS).
Materials and Methods : From January 2001 to December 2001, the authors retrospectively studied 26 con-
secutive patients who were admitted to the coronary care unit, Chest disease Institute with ACS. The admis-
sion 12-lead EKGs,chest X-ray, troponin T, creatine phosphokinase (CPK), creatine kinase MB fraction (CK
MB) and blood chemistry including fasting blood sugar, renal function test (BUN and creatinine), electrolytes
and lipid profiles were obtained and analyzed before coronary angiogram. CAG was performed in all within
48 hours after admission. The admission 12-lead EKGs and angiographic coronary artery lesions were
analyzed.
Results : There were 26 patients (M:F = 21:5) with a mean age of 64 + 9 yr.The culprit lesions were located at
the left main coronary artery (LM) in 5 (19%), the left anterior descending artery (LAD) in 8 (31%), the right
coronary artery (RCA) in 11 (42%) and the left circumflex artery (LCX) in 2 (8%). Of these, aVRSTE (> 0.1 mV)
was detected in 9 (35%), 4 in the LM group (80%). 3 in the RCA group (27%) and 2 in the LAD group (25%).
The findings of aVRSTE distinguished the LM group from the non LM group (LAD, RCA and LCX ), with 80%
sensitivity, 76% specificity and 77% accuracy.
Conclusion : In patients with acute coronary syndrome, lead AVR ST segment elevation is associated with the
culprit left main coronary lesion.
Keywords : Lead aVR ST segment evaluation (aVRSTE), Acute coronary syndrome (ACS), Electrocardio- graphy (ECG)
