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September 7, 2011 by dailybolusoflr
ST elevation in Lead aVR
This lead is an often unrecognized location to look for ST elevation.
- ST elevation of greater than 0.5mm in lead aVR is associated with left main disease or triple vessel disease.
- Several studies have looked at the predictive value and sensitivity of this finding
- Sensitivity of this finding in predicting left main obstruction is around 80%
- The importance of this finding in patients with concern for ACS is related to the following:
- A high likelihood that CABG will be the treatment of choice (this is important as STEMI in patients with left main disease is associated with significant morbidity if treated with lytics as they often need urgent CABG and have an increased complication rate after recent fibrinolysis)
- A number of studies show that this group of patients with STE in lead aVR have significant in -hospital mortality and higher 90 day adverse outcome
AJEM (2006) 24; 864-874