Zil, Ahmad Masood Akbar, Sajjad Ahmada.
ST-segment depression in lead AVR can predict culprit artery in acute inferior wall myocardial infarction.
J Cardiovascular Dis Jan ;11(2):28-32.

ABSTRACT OBJECTIVE :To determine the diagnostic accuracy of ST-segment depression in lead aVR for prediction of Left Circumflex artery (LCx artery) as infarct related artery (IRA) in patients having acute inferior wall ST elevation myocardial infarction (STEMI) using coronary angiography as gold standard. METHODS: The study was conducted at Punjab Institute of Cardiology, Lahore from June, 2012 to December, 2012. All consecutive patients admitted with the diagnosis of acute inferior wall myocardial infarction (IWMI) and their coronary angiographies performed during same admission were studied. The ECG and angiographic findings were then correlated to establish the predictive value of ST depression in aVR in determining the IRA in the setting of acute inferior wall STEMI. RESULTS: A total of 170 patients, 133 (78.2%) men and 37 (21.8%) women, were studied. Age of the patients was between 30and 70 years. STD in aVR was noted in 98 patients; among these left circumflex coronary artery was the IRA in 55 (56.1%) and RCA in 43 (43.9%). Sensitivity, specificity, positive predictive value and negative predictive value of STD in aVR for diagnosis of LCx artery as IRA were 80.88%, 57.84%, 56.12% and 81.94% respectively. CONCLUSIONS: ST-depression in aVR can be used for predicting LCx artery as IRA in acute inferior wall STEMI with >80 % sensitivity and negative predictive value. KEY WORDS: Inferior wall myocardial infarction, ST-depression in aVR, infarct-related artery.

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