Predictive value of lead aVR for lesions in the proximal portion of the left anterior descending coronary artery

OBJECTIVES
We aimed to investigate the predictive value of lead aVR in the evaluation of electrocardiograms (ECG) for lesions in the proximal portion of the left anterior descending (LAD) coronary artery.

STUDY DESIGN
The study consisted of 361 patients (293 males, 68 females; mean age 58±10 years; range 24 to 84 years) with acute myocardial infarction (AMI), who presented with typical chest pain and ST elevation on ECG. All of the patients underwent coronary angiography (CAG) in order to identify the infarct-related artery (IRA) and its segments. Changes in the ST segment (i.e. elevation or depression) were evaluated in all leads including aVR. The patients were divided into two groups according to the ST elevation recorded in lead aVR, namely as positive (≥0.5 mm) or negative (<0.5 mm).

RESULTS
The IRA segment was in the proximal LAD in 54% of the aVR positive group, and in 9% of the aVR negative group (p<0.001). Multiple vessel coronary artery disease was more common in the aVR positive group (p<0.001). There was a weak correlation between ST segment elevations in lead aVR and the Gensini score (r=0.21, p=0.002). In patients with anterior AMI, ST elevation in lead aVR predicted the IRA segment in the proximal LAD with 47% sensitivity, 91% specificity, 81% negative predictive value, 68% positive predictive value, and 78% diagnostic accuracy.

CONCLUSION
In patients with anterior AMI, evaluation of aVR lead may be useful in localizing the IRA segment in the proximal LAD and predicting that an increased amount of myocardial tissue is at risk.