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Abstract：
UNASSIGNED: The value of ST-elevation in lead augmented vector right (aVR) remains controversial in clinical practice. This study aimed to investigate the association of simultaneous ST-elevation in lead aVR and III with angiographic findings and clinical outcomes in patients with non-ST-elevation acute coronary syndromes (NSTEACS).
UNASSIGNED: In this observational study, patients who had been diagnosed with NSTEACS and presented with ST-elevation in lead aVR and without ST-elevation in any other two contiguous leads were enrolled from January 2018 to June 2019. Demographic, baseline clinical, angiographic and interventional characteristics as well as clinical outcomes were collected and recorded on standardized case report forms.
UNASSIGNED: A total of 157 patients meeting the criteria were finally enrolled in this study and classified into two groups according to the presence of ST-elevation in lead III. Patients in the two groups were similar in average age and previous history of hypertension, diabetes mellitus, hyperlipidemia, chronic kidney disease, stroke, and peripheral vascular diseases (all P>0.05). Patients with ST-elevation in lead III tended to present with myocardial hypertrophy in the echocardiography (P=0.02). The cases with ST-elevation in lead III showed higher high sensitivity troponin T (hs-TnT; P=0.08) and creatinine kinase MB isoenzyme (CK-MB; P<0.01) whereas those without ST-elevation in lead III showed higher N-terminal pro brain natriuretic peptide (NT-proBNP; P=0.02). Of note, patients with ST-elevation in lead III presented with more ST-depression in multiple leads [especially in lead I, augmented vector left (aVL), V3-V6] as well as higher degree of ST-depression (all P<0.05) and were more likely to develop multi-vessel and left main trunk (LM) lesions (P=0.04), with 20% of the cases having a LM lesion and 60% having triple vessel lesions. Patients with ST-elevation in lead III were at increased risk of 3-year major adverse cardiovascular events (MACEs), despite no significant statistical difference between the two groups (hazard ratio =1.29; P=0.26).
UNASSIGNED: The NSTEACS cases with simultaneous ST-elevation in lead III and aVR tended to present with more multiple leads with ST-depression, higher degree of ST-depression, and more LM or multi-vessel lesions, suggesting a broader range of severe myocardial ischemia. The concurrent presentation of ST-elevation in lead III and aVR may play a vital role in the diagnosis, risk-stratification, and prediction of poor prognosis during the management of NSTEACS patients.
UNASSIGNED: In this observational study, patients who had been diagnosed with NSTEACS and presented with ST-elevation in lead aVR and without ST-elevation in any other two contiguous leads were enrolled from January 2018 to June 2019. Demographic, baseline clinical, angiographic and interventional characteristics as well as clinical outcomes were collected and recorded on standardized case report forms.
UNASSIGNED: A total of 157 patients meeting the criteria were finally enrolled in this study and classified into two groups according to the presence of ST-elevation in lead III. Patients in the two groups were similar in average age and previous history of hypertension, diabetes mellitus, hyperlipidemia, chronic kidney disease, stroke, and peripheral vascular diseases (all P>0.05). Patients with ST-elevation in lead III tended to present with myocardial hypertrophy in the echocardiography (P=0.02). The cases with ST-elevation in lead III showed higher high sensitivity troponin T (hs-TnT; P=0.08) and creatinine kinase MB isoenzyme (CK-MB; P<0.01) whereas those without ST-elevation in lead III showed higher N-terminal pro brain natriuretic peptide (NT-proBNP; P=0.02). Of note, patients with ST-elevation in lead III presented with more ST-depression in multiple leads [especially in lead I, augmented vector left (aVL), V3-V6] as well as higher degree of ST-depression (all P<0.05) and were more likely to develop multi-vessel and left main trunk (LM) lesions (P=0.04), with 20% of the cases having a LM lesion and 60% having triple vessel lesions. Patients with ST-elevation in lead III were at increased risk of 3-year major adverse cardiovascular events (MACEs), despite no significant statistical difference between the two groups (hazard ratio =1.29; P=0.26).
UNASSIGNED: The NSTEACS cases with simultaneous ST-elevation in lead III and aVR tended to present with more multiple leads with ST-depression, higher degree of ST-depression, and more LM or multi-vessel lesions, suggesting a broader range of severe myocardial ischemia. The concurrent presentation of ST-elevation in lead III and aVR may play a vital role in the diagnosis, risk-stratification, and prediction of poor prognosis during the management of NSTEACS patients.
摘要：
■导联增强向量右（aVR）的ST抬高值在临床实践中仍存在争议。本研究旨在探讨aVR和III导联同时ST段抬高与非ST段抬高急性冠脉综合征（NSTEACS）患者的血管造影结果和临床结果的关系。
■在这项观察性研究中，纳入了2018年1月至2019年6月被诊断为NSTEACS,aVR导联有ST抬高,其他任何两个连续导联无ST抬高的患者.人口统计,基线临床，收集血管造影和介入特征以及临床结果,并记录在标准化病例报告表中.
■最终纳入符合该标准的157名患者，并根据III导联ST抬高的存在将其分为两组。两组患者的平均年龄和既往高血压病史相似，糖尿病,高脂血症,慢性肾病,中风,外周血管疾病(P均>0.05)。III导联ST抬高的患者在超声心动图中倾向于出现心肌肥大（P=0.02）。III导联ST升高的病例显示较高的高敏肌钙蛋白T（hs-TnT；P=0.08）和肌酐激酶MB同工酶（CK-MB；P<0.01），而III导联无ST升高的病例显示较高的N末端脑钠肽前体（NT-proBNP；P=0.02）。值得注意的是，III导联ST抬高的患者在多个导联中表现出更多的ST压低[尤其是在I导联中，左增广向量(aVL)，V3-V6]以及较高程度的ST压低（均P<0.05），并且更容易发生多血管和左主干（LM）病变（P=0.04），20%的病例有LM病变，60%有三重血管病变。III导联ST段抬高的患者3年主要不良心血管事件（MACE）的风险增加，尽管两组之间没有显着统计学差异（风险比=1.29；P=0.26）。
■III导联和aVR同时ST抬高的NSTEACS病例倾向于出现更多的ST压低导联，ST段抑郁程度较高，更多的LM或多血管病变，提示更广泛的严重心肌缺血。III导联和aVR中同时出现ST段抬高可能在诊断中起重要作用。风险分层，并预测NSTEACS患者治疗期间的不良预后。
■在这项观察性研究中，纳入了2018年1月至2019年6月被诊断为NSTEACS,aVR导联有ST抬高,其他任何两个连续导联无ST抬高的患者.人口统计,基线临床，收集血管造影和介入特征以及临床结果,并记录在标准化病例报告表中.
■最终纳入符合该标准的157名患者，并根据III导联ST抬高的存在将其分为两组。两组患者的平均年龄和既往高血压病史相似，糖尿病,高脂血症,慢性肾病,中风,外周血管疾病(P均>0.05)。III导联ST抬高的患者在超声心动图中倾向于出现心肌肥大（P=0.02）。III导联ST升高的病例显示较高的高敏肌钙蛋白T（hs-TnT；P=0.08）和肌酐激酶MB同工酶（CK-MB；P<0.01），而III导联无ST升高的病例显示较高的N末端脑钠肽前体（NT-proBNP；P=0.02）。值得注意的是，III导联ST抬高的患者在多个导联中表现出更多的ST压低[尤其是在I导联中，左增广向量(aVL)，V3-V6]以及较高程度的ST压低（均P<0.05），并且更容易发生多血管和左主干（LM）病变（P=0.04），20%的病例有LM病变，60%有三重血管病变。III导联ST段抬高的患者3年主要不良心血管事件（MACE）的风险增加，尽管两组之间没有显着统计学差异（风险比=1.29；P=0.26）。
■III导联和aVR同时ST抬高的NSTEACS病例倾向于出现更多的ST压低导联，ST段抑郁程度较高，更多的LM或多血管病变，提示更广泛的严重心肌缺血。III导联和aVR中同时出现ST段抬高可能在诊断中起重要作用。风险分层，并预测NSTEACS患者治疗期间的不良预后。
