Cardiac rupture and admission electrocardiography in acute anterior myocardial infarction: Implication of ST elevation in aVL

This study determines the usefulness of electrocardiography in the emergenc y room for assessing the risk of cardiac rupture after acute anterior myoca rdial infarction (MI). The presence of ST segment elevation on the admissio n 12-lead electrocardiography was evaluated in 325 consecutive anterior MI patients. A forward-stepwise logistic regression analysis for cardiac ruptu re was performed with the covariates of age, gender, hypertension, history of MI, reperfusion therapy by coronary angioplasty, and ST segment elevatio ns in leads I, aVL, V1-V6. Cardiac rupture occurred in 16 patients, includi ng 7 with left ventricular free wall rupture (FWR) and 9 with ventricular s eptal perforation (VSP). For FWR, ST elevation in lead aVL was the only ind ependent predictor (odds ratio = 12.1, P = .0215). For VSP, female gender ( odds ratio = 5.32, P = .0201) was the independent predictor. In conclusion, in patients with acute anterior MI, ST segment elevation in lead aVL on th e admission electrocardiography is a significant risk factor for left ventr icular FWR.