ST-segment depression in lead aVR predicts predischarge left ventricular dysfunction in patients with reperfused anterior acute myocardial infarctionwith anterolateral ST-segment elevation

Background Patients with on anterolateral acute myocardial infarction (AMI) have a worse prognosis, and those with additional inferolateral wall invol vement might be higher risk because of more extensive area at risk, Lead -a VR obtained by inversion of images in lead aVR has been reported to provide useful information For inferolateral lesion. Methods we examined the relation between ST-segment deviation in lead aVR o n admission electrocardiogram (ECG) and left ventricular function in 105 pa tients with an anterolateral AMI undergoing successful reperfusion less tha n or equal to6 hours after onset. Patients were classified according to ST- segment deviation in lead aVR on admission EGG: group A, 23 patients with S T elevation of greater than or equal to0.5 mm; group B, 47 patients without ST deviation; and group C, 35 patients with ST depression of greater than or equal to0.5 mm. Results. There were no differences among the 3 groups in age, sex, or site of the culprit lesion. In groups A, B, and C, the peak creatine kinase leve l was 3661 +/- 1428, 4440 +/- 1889, and 6959 +/- 2712 mU/mL, and the left v entricular election fraction (LVEF) measured by predischarge left ventricul ography was 54% +/- 9%, 48% +/- 7%, and 37% +/- 9%, respectively (P < .01). During hospitalization, congestive heart failure occurred more frequently in group C than in groups A or B (P < .05). ST-segment depression in lead a VR had a higher predictive accuracy than other ECG findings in identifying patients with predischarge LVEF less than or equal to 35%. Conclusions we conclude that in patients with an anterolateral AMI, ST-segm ent depression in lead aVR on admission ECG is useful for predicting larger infarct and left ventricular dysfunction despite successful reperfusion.