Object

Title: Prognostic significance of ST segment changes in lead aVR in acute inferior myocardial infarction

Abstract:

Background. Inferior myocardial infarction with ST segment elevation is considered a low risk STEMI but 30- 40% patients with inferior STEMI present complications during in-hospital stay, which is associated with a bad prognosis. The aim of the study. The purpose of the study was to determine whether or not the ST segment changes in lead aVR could predict short and long term prognosis in inferior STEMI, depending on the mode of treatment, and to assess the correlation between electrocardiographic and angiographic data. Material and methods. The data of 320 consecutive patients with inferior STEMI were analyzed, 206 men and 114 women, in the average age of 65,6±11,1 years. The patients were divided into 2 groups : group A– treated with primary angioplasty-134 patients, 81 men and 53 women, in the average age of 66,1±10,6 years. Group B– treated not invasively - 186 patients, 125 men and 61 women, in the average age of 65,2 ±11,9 years. The reperfusion treatment was applied in 230 (72%) patients, 160 (70%) men 70 (30%) women. During in-hospital stay 29 (9.0%) deaths occurred, 7 (7.3%) deaths in the fibrinolytic group, 11 (8.2%) deaths in PCI patients and 11 (12.2%) deaths in patients without the reperfusion therapy. Results. ST segment changes in lead aVR were observed in 135 (42.2%) patients, ST elevation in 47 (14.7%), ST depression in 88 (27.5%) patients. In 185(57.8%) patients ST segment changes in lead aVR were not observed. In patients with ST segment elevation, ST depression and without ST changes the mortality rate was : 27.7%, 16.5% and 1.0%, p<0.001, respectively. The infarct related artery (IRS) was RCA in 113 (84.3%) patients and Cx in 18 (15.7%) patients. In the multivariate analysis the predictors of ST segment elevation in lead aVR were : sex (female), diabetes, hypertension, lower ejection fraction (EF%), cardiogenic shock on admission. Conclusion. ST segment changes in lead aVR in inferior STEMI are frequent and present in about 50% of the patients. The presence of ST segment changes (ST elevation and ST depression) in lead aVR is associated with a poor prognosis and it is independent of the type of the treatment strategy. These changes predict a poorer long-term prognosis in the 12- month follow-up. The presence and character of ST segment changes in lead aVR are not useful in identifying the IRA and the site of its occlusion. Patients with inferior STEMI with ST segment changes in lead aVR should be considered as a high risk group and the invasive treatment should be the method of choice in these patients.

Level of degree:

2 - studia doktoranckie

Degree discipline:

choroby układu krążenia

Degree grantor:

Wydział Lekarski

Promoter:

Leszek Bryniarski

Date issued:

2009

Format:

application/pdf

Identifier:

oai:dl.cm-uj.krakow.pl:924

Call number:

ZB-110287

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Access rights:

nieograniczony

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego - Collegium Medicum

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Last modified:

Sep 12, 2019

In our library since:

Nov 21, 2012

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Number of object content views in PDF format

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All available object's versions:

http://dl.cm-uj.krakow.pl:8080/publication/924

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ZB-110287 Sep 12, 2019
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