心电图aVR导联ST段抬高幅度与ST段抬高型心肌梗死患者梗死相关血管及预后的相关性OA

Objective To explore the effect of ST-segment elevation amplitude in lead aVR on infarct-related artery(IRA)localization,preprocedural thrombolysis in myocardial infarction(TIMI)flow grade,and prognosis in different onset time windows(＜6 hours,6 to 12 hours)in patients with ST-segment elevation myocardial infarction(STEMI).Methods A total of 368 STEMI patients with e-mergency primary percutaneous coronary intervention(pPCI)at Suqian Hospital of Jiangsu Provincial People's Hospital from January 2021 to June 2023 were retrospectively enrolled.According to the ST-segment elevation amplitude in lead aVR(80 ms after the J point,with the TP segment as the baseline)on the 12-lead electrocardiogram immediately at admission,patients were divided into group A(n=132,＜0.1 mV),group B(n=151,0.1 to 0.2 mV)and group C(n=85,＞0.2 mV).Patients were further divided into＜6 h subgroup(n=223)and 6 to 12 h subgroup(n=145)according to the onset time window.Baseline characteristics,onset time window,IRA type and TIMI flow grade of patients were collected,and major adverse cardiovascular events(MACE)at 30 days and 1 year were recorded during follow-up.The receiver operating characteristic(ROC)curve was drawn to analyze the optimal cut-off value of aVR elevation amplitude.Results Significant differences in age,prevalence of diabetes,peak cardiac troponin I(cTnI),left ventricular ejection fraction(LVEF)and proportion of preprocedural TIMI 0 to 1 flow were found among the three groups(P＜0.05).The distribution of IRA types showed significant differences among the three groups(x2=46.928,P＜0.001);group A was dominated by right coronary artery(RCA)lesions(50.8％),followed by left anterior descending artery(LAD)lesions(35.6％);group B had the highest pro-portion of LAD lesions(44.4％),of which proximal lesions accounted for 40.4％;in group C,there were 19 cases of left main(LM)lesions(22.4％)and 45 cases of proximal LAD lesions(52.9％),and the total proportion of the two types reached 75.3％,which was significantly higher than 24.2％in group A and 49.7％in group B.The ROC curve showed that aVR elevation＞0.2 mV had a sensitivity of 76.5％,a specificity of 85.2％and a Youden index of 0.617 for predicting LM/proximal LAD lesions.The total incidence of MACE at 30 days and 1 year during follow-up was 16.9％(61/360)and 27.8％(100/360),respectively.The 30-day and 1-year MACE incidences in group C(31.8％,60.0％)were significantly higher than those in group B(14.6％,21.9％)and group A(9.1％,12.1％)(Log-rank x2=41.893,48.257,both P＜0.001).Multivariate Cox regression model showed that ST-segment elevation＞0.2 mV in lead aVR(HR=3.512,95％CI,2.156 to 5.718,P＜0.001),preprocedural TIMI 0 to 1 flow(HR=2.735,95％CI,1.658 to 4.509,P＜0.001),age ≥70 years(HR=2.218,95％CI,1.362 to 3.607,P=0.001)and LVEF＜45％(HR=2.643,95％CI,1.612 to 4.338,P＜0.001)were independent risk factors for 1-year MACE in STEMI patients.Conclusion ST-segment elevation amplitude＞0.2 mV in lead aVR on electrocardiogram indicates a high probability that the IRA is LM or proximal LAD in STEMI patients,and it is often accompanied by poor preprocedural TIMI flow.This indicator has predictive value for the prognosis of STEMI patients in different onset time windows,and can be used as a key indicator for emergency risk stratification.