ST-segment elevation resolution in lead aVR - A strong predictor of adverse outcomes in patients with non-ST-segment elevation acute coronary syndrome

Background The impact of ST-segment elevation resolution in lead aVR on outcomes in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) is unclear. Methods and Results Electrocardigrams (ECGs) were recorded on admission and 6h later in 367 patients with NSTE-ACS. ST-segment deviation >= 0.5 mm was considered significant: 92 patients had ST-segment elevation in lead aVR on admission ECG (ST up arrow aVR), and 275 did not. Among patients with ST up arrow aVR, 50 had ST resolution, defined as a reduction >50% in the degree of ST-segment elevation in lead aVR from admission to 6h later, and 42 did not. ST up arrow aVR without ST resolution was associated with older age, greater ST-segment depression in other leads on admission and 6h later, higher rates of positive troponin T, left main and/or 3-vessel coronary disease, and adverse events such as death, (re)infarction, or urgent revascularization within 30 days after admission. Multivariate analysis showed that ST up arrow aVR without ST resolution was the strongest independent predictor of death or (re)infarction within 30 days after admission (hazard ratio 5.62, p=0.0 18). Conclusions ST up arrow aVR without ST resolution is a strong predictor of 30-day adverse outcomes and correlates with the extent and severity of coronary artery disease in patients with NSTE-ACS.