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2015, Number 4

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Rev Cubana Cardiol Cir Cardiovasc 2015; 21 (4)

Prognosis value of ST elevation segment in lead aVR in non ST segment elevation acute co-ronary syndrome

García HRA, Prohías MJA, Rivero SL, Leyva QAY, Sánchez CR, Tirado CY

Language: Spanish
References: 20
Page:
PDF size: 330.88 Kb.


ABSTRACT

Introduction: St elevation segment in lead aVR of basal electrocardiogram provides an important prognosis information in patients with non st-segment elevation acute coronary syndrome.
Objective: To evaluate the relation of ST segment elevation in lead aVR in patients with non-st segment elevation acute coronary syndrome and the occurrence of death in 1 year follow.
Method: A retrospective study was conducted in patients that were admitted in the Coronary Unit of Hermanos Ameijeiras Hospital with a first diagnosis of non-st segment elevation acute coronary syndrome from May 2011 to August 2013.
Results: 65 years and more(41.8 % and 40.0 %, masculine gender (67.3 % and 64.5 %) and more than two comorbilities (78.2 % and 67.3 %) were predominant in both study groups. Unstable angina (63.6 % and 66.3%) and Killip I class (61.8 % and 80.9 %) were frequent. Latest stage of Killip class and multivessels coronary disease were observed in st segment elevation aVR group (12.7% vs 4.5% [p=0.03]; 5.5% vs 0.9% [p=0.03] and (76.8 % [p=0.02]). Death at 1 year-follow occurs in 25.5 % (p=0.003 OR 2.54 IC 95% 1.33-4.85) in st segment elevation aVR group.
Conclusion: st segment elevation in lead aVR is an important electrocardiograph predictor of death at 1 year-follow. It is useful to improve early risk stratification and management of these patients.


REFERENCES

  1. Gaziano MJ. Repercusión global de las enfermedades cardiovasculares. En: Braundwald E, Zipes DE, Libby P, Bonow RO, editores. Tratado de Cardio-logía. 7 Ed. España: Elsevier; 2006. p. 1-26.

  2. Rayner M, Allender S, Scarborough P. Cardiovascular disease in Europe. European Journal of Cardiovascular Prevention and Rehabilitation. 2009, 16 (Suppl 2):S43-7.

  3. Go SA, Mozaffarian D, Roger L V, Benjamin JE, Berry DJ, Borden BW, et al. Heart Disease and Stroke Statistics 2013 Update. A report from the American Heart Association. Circulation 2013; 127 (1):e6-e245.

  4. Cuba. Ministerio de Salud Pública. Anuario Estadístico de Salud. LabHaba-na, Dirección Nacional de Estadística, 2012.

  5. Diercks DB, Peacock WF, Hiestand BC, Chen AY, Pollack CV Jr, Kirk JD, et al. Frequency and consequences of recording an electrocardiogram 10 min after arrival in an emergency room in non-ST-segment elevation acute coro-nary syndromes (from the CRUSADE Initiative). Am J Cardiol. 2006; 97(4):437-42.

  6. Savonitto S, Ardissino D, Granger CB, Morando G, Prando MD, Mafrici A, et al. Prognostic value of the admission electrocardiogram in acute Coronary syndromes. JAMA. 1999; 281 (8):707-13.

  7. Bonaca MP, Wiviott SD, Braunwald E, Murphy SA, Ruff CT, Antman EM, et al. American College of Cardiology/American Heart Associa-tion/European Society of Cardiology/World Heart Federation Universal De-finition of Myocardial Infarction Classification System and the Risk of Car-diovascular Death Observations From the TRITON-TIMI 38 Trial (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhi-bition With Prasugrel–Thrombolysis in Myocardial Infarction 38). Circula-tion. 2012; 125(4):577-83.

  8. Barrabés JA, Figueras J, Moure C, Cortadellas J, Soler-Soler J. Prognostic-value of lead aVR in patients with a first non–ST- Segment elevation acute myocardial infarction. Circulation 2003; 108 (7):814–9.

  9. Kosuge M, Kimura K, Ishikawa T, Ebina T, Hibi K, Tsukahara K et al.Combined prognostic utility of ST segment in lead aVR and troponin T onadmission in non- ST segment elevation acute coronary syndromes. Am JCardiol2006; 97 (3):334 –9.

  10. Bosch X, López de Sá E, Sendón LJ, Aboal J, Miranda-Guardiola F,Bethencourt A, et al. Perfil clínico, pronóstico y variabilidad en el trata-mientodel síndrome coronario agudo sin elevación del segmento ST. Datos delregistro PEPA. Rev Esp Cardiol 2003; 56 (4):346-53.

  11. Kosuge M, Ebina T, Hibi K, Endo M, Komura N, Hashiba K, et al. ST-Segment elevation resolution in lead aVR- A strong predictor of Adverse Outcomes in patiens with Non ST-Segment Elevation Acute Coronary Syn-drome. Circ J 2008; 72 (7): 1047-53.

  12. Saleem FM, Sainz BG, Cáceres L FM, Román R PA, Armas R NB, Farray MG. Caracterización del síndrome coronario agudo en el Instituto de Car-diología y Cirugía Cardiovascular, 2009-2010. Rev Cubana Cardiol Cir Car-diovasc. 2010; 16 (4):397-406.

  13. Del Pino S E, Pérez del Todo JM, Quiroz J LJ, Cortés R V, Torres S N. Diferencias por sexo del síndrome coronario agudo sin elevación del seg-mento ST en la Unidad de Cuidados Coronarios. Rev Cubana Cardiol Cir Cardiovasc. 2011; 17 (4):304-10.

  14. Rubiera R, Lara A, Iván N, Palacio H, Vignier D. Síndrome coronario agudo. Caracterización clínico epidemiológica. A propósito de nuestro pri-mer año. Revista Cubana de Medicina Intensiva y Emergencias 2009; 8 (3):7-12.

  15. Wong KC, Gao W, Stewart HA R, French KJ, Aylward GE P, White DH. The prognostic meaning of the full spectrum of aVR ST segment changes in acute myocardial infarction. Eur Heart J.2012; 33 (3):384-92.

  16. Taglieri N, Marzocchi A, Saia F, Marozzini C, Palmerini T, Ortolani P, et al. Short – and long –Term Prognostic Significance of ST-Segment Elevation in Lead aVR in patiens with Non-ST-Segment Elevation Acute Coronary Syn-drome. Am J Cardiol. 2011; 108 (1):21-8.

  17. Yamaji H, Iwasaki K, Kusachi S, Murakami T, Hirami R, Hamamoto H, et al. Prediction of acute left main coronary artery obstruction by 12 lead elec-trocardiography: ST segment elevation in lead avr with less st segment ele-vation in lead V1. J Am Coll Cardiol.2001; 38 (5):1348-54.

  18. Yan AT, Yan RT, Kennelly BM, Anderson Jr FA, Budaj A, López-Sendón J, et al. Relationship of st elevation in lead aVR with angiographic findings and outcome in non st elevation acute coronary syndrome. Am Heart J.2007; 154 (1):71-8.

  19. Kosuge M, Ebina T, Hibi K, Iwahashi N, Meajima N, Endo M, et al. ST-segment elevation in lead AVR strongly predicts adverse outcomes at 1 year in patients with non-ST-segment elevation acute coronary syndrome. Circu-lation.2011; 124(43): 81-96.

  20. Szymański MF, Grabowski M, Filipiak JK, Karpiński G, Opolski G. Admis-sion St segment elevation in lead AVR as the factor improving complex risk stratification in acute coronary syndromes. Am J Emerg Med. 2008; 26 (4):408-12.




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