Effect of lead aVR on recent prognosis in patients with non-ST-elevation acutecoronary syndrome

Objective To investigate the effect of lead aVR on recent prognosis in patients with non-ST-elevation acutecoronary syndrome(NSTE-ACS). Methods 195 patients with NSTE-ACS were divided into ST segment elevation in lead aVR group(n=54 cases) and non-ST segment elevation in lead aVR group(n=141) according to ST segment elevation in lead on admission; clinical data, laboratory index and coronary artery lesion were recorded, and major adverse cardiac (MACE) in hospitalization time were also recorded. Results Compared with non-ST segment elevation in the lead aVR group, the heart rate of ST segment elevation in the lead aVR group was faster[(85.4±12.0) beats per minute vs.(79.3±13.2) beats per minute, t=2.959, P<0.05], systolic blood pressure and diastolic blood pressure were higher[(145.0±20.3)mmHg vs.(136.0±19.4)mmHg, t=2.874, P<0.05]; NT-proBNP[(743.9±125.8)pg/mL vs.(416.4±95.3)pg/mL, t=19.625, P<0.05], cTnI[(3.4±1.0)ng/mL vs.(1.2±0.4)ng/mL, t=21.994, P<0.05], CK-MB[(31.5±9.8)ng/mL vs.(19.8±6.5)ng/mL, t=9.682, P<0.05]were higher (P<0.05); LVEF were lower[(50.1±5.2)% vs.(53.8±5.7)%, t=4.153, P<0.05]; the rate and amplitude of low ST segment in outside lead aVR also was higher[(9.5±3.8)mm vs.(7.4±2.8)mm, t=4.224, P<0.05]; the rate of left main and three-vessel disease in ST segment elevation in lead aVR group were higher (P<0.05). Compared with non-MECE group, proportion of ST segment elevation in lead AVR on admission was higher (P<0.05). Logistic regression analysis showed that heart rate(OR=1.472), NT-proBNP(OR=1.732), cTnI(OR=1.893), left main coronary artery(OR=2.478) and three-vessel disease (OR=2.310) were risk for ST segment elevation in lead AVR(P<0.05). Logistic regression analysis also showed that ST segment elevation in lead AVR were risk for MACE(OR=1.474). Conclusion ST segment elevation in lead AVR has close relationship with large area of myocardial ischemia, and patients prognosis is poorer, which may be independent risk factor for the recent outcomes of patients with NSTE-ACS.Early record of the change in the case of aVR lead ECG ST segment NSTE-ACS patients is of important value in evaluation of the condition and prognosis. Key words: Acute coronary syndrome; Coronary artery disease; Electrocardiogram (ecg); AVR lead