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dc.contributor.authorYan, Andrew T.
dc.contributor.authorYan, Raymond T.
dc.contributor.authorKennelly, Brian M.
dc.contributor.authorAnderson, Frederick A. Jr.
dc.contributor.authorBudaj, Andrzej
dc.contributor.authorLopez-Sendon, Jose
dc.contributor.authorBrieger, David
dc.contributor.authorAllegrone, Jeanna
dc.contributor.authorSteg, Phillippe Gabriel
dc.contributor.authorGoodman, Shaun G.
dc.date2022-08-11T08:08:08.000
dc.date.accessioned2022-08-23T15:44:04Z
dc.date.available2022-08-23T15:44:04Z
dc.date.issued2007-06-23
dc.date.submitted2011-09-23
dc.identifier.citationAm Heart J. 2007 Jul;154(1):71-8. <a href="http://dx.doi.org/10.1016/j.ahj.2007.03.037">Link to article on publisher's site</a>
dc.identifier.issn0002-8703 (Linking)
dc.identifier.doi10.1016/j.ahj.2007.03.037
dc.identifier.pmid17584554
dc.identifier.urihttp://hdl.handle.net/20.500.14038/27235
dc.description.abstractBACKGROUND: Limited data suggest that ST elevation (ST elevation) in aVR is associated with higher mortality and more extensive coronary artery disease in the setting of non-ST elevation acute coronary syndromes (ACS). METHODS: In the prospective Global Registry of Acute Coronary Events (GRACE) electrocardiographic substudy, the admission electrocardiograms were analyzed by a blinded core laboratory. We performed multivariable analysis to determine (1) the independent prognostic significance of ST elevation in aVR and (2) its association with significant (> or = 50% stenosis) left main or 3-vessel disease (LM/3-vd). RESULTS: Among 5064 patients with non-ST elevation ACS, 4696 had no ST elevation in aVR, 292 (5.8%) had minor (0.5-1 mm) ST elevation in aVR, and 76 (1.5%) had major (>1 mm) ST elevation in aVR; their in-hospital mortality rates were 4.2%, 6.2%, and 7.9%, respectively (P for trend =.03). At 6 months follow-up, the cumulative mortality rates were 7.6%, 12.7%, and 18.3%, respectively (log-rank P for trend <.001). However, minor and major ST elevation in aVR were not independent predictors of in-hospital or 6-month death after adjusting for other validated prognosticators in the GRACE risk model. Of the 2416 patients without prior coronary bypass surgery who underwent cardiac catheterization, the prevalence of LM/3-vd was 26.1%, 36.2%, and 55.9% for the groups with no, minor, and major ST elevation in aVR, respectively (P for trend <.001). After adjusting for other clinical characteristics, major ST elevation in aVR remained an independent predictor of LM/3-vd (adjusted odds ratio, 2.68; 95% confidence interval, 1.29-5.58; P = .008). CONCLUSION: ST elevation in aVR is less prevalent than reported in previous smaller studies. Although it is associated with higher unadjusted in-hospital and 6-month mortality, it does not provide incremental prognostic value beyond comprehensive risk stratification using the validated GRACE risk model. However, ST elevation greater than 1 mm in aVR may be useful in the early identification of LM/3-vd in ACS patients with ST depression.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=17584554&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1016/j.ahj.2007.03.037
dc.subjectAged
dc.subject*Coronary Angiography
dc.subjectCoronary Disease
dc.subject*Electrocardiography
dc.subjectFemale
dc.subjectHumans
dc.subjectMale
dc.subjectModels, Statistical
dc.subjectPrognosis
dc.subjectProspective Studies
dc.subjectRegistries
dc.subjectRisk Assessment
dc.subjectSurvival Rate
dc.subjectTreatment Outcome
dc.subjectHealth Services Research
dc.titleRelationship of ST elevation in lead aVR with angiographic findings and outcome in non-ST elevation acute coronary syndromes
dc.typeArticle
dc.source.journaltitleAmerican heart journal
dc.source.volume154
dc.source.issue1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/cor_grace/55
dc.identifier.contextkey2254975
html.description.abstract<p>BACKGROUND: Limited data suggest that ST elevation (ST elevation) in aVR is associated with higher mortality and more extensive coronary artery disease in the setting of non-ST elevation acute coronary syndromes (ACS).</p> <p>METHODS: In the prospective Global Registry of Acute Coronary Events (GRACE) electrocardiographic substudy, the admission electrocardiograms were analyzed by a blinded core laboratory. We performed multivariable analysis to determine (1) the independent prognostic significance of ST elevation in aVR and (2) its association with significant (> or = 50% stenosis) left main or 3-vessel disease (LM/3-vd).</p> <p>RESULTS: Among 5064 patients with non-ST elevation ACS, 4696 had no ST elevation in aVR, 292 (5.8%) had minor (0.5-1 mm) ST elevation in aVR, and 76 (1.5%) had major (>1 mm) ST elevation in aVR; their in-hospital mortality rates were 4.2%, 6.2%, and 7.9%, respectively (P for trend =.03). At 6 months follow-up, the cumulative mortality rates were 7.6%, 12.7%, and 18.3%, respectively (log-rank P for trend <.001). However, minor and major ST elevation in aVR were not independent predictors of in-hospital or 6-month death after adjusting for other validated prognosticators in the GRACE risk model. Of the 2416 patients without prior coronary bypass surgery who underwent cardiac catheterization, the prevalence of LM/3-vd was 26.1%, 36.2%, and 55.9% for the groups with no, minor, and major ST elevation in aVR, respectively (P for trend <.001). After adjusting for other clinical characteristics, major ST elevation in aVR remained an independent predictor of LM/3-vd (adjusted odds ratio, 2.68; 95% confidence interval, 1.29-5.58; P = .008).</p> <p>CONCLUSION: ST elevation in aVR is less prevalent than reported in previous smaller studies. Although it is associated with higher unadjusted in-hospital and 6-month mortality, it does not provide incremental prognostic value beyond comprehensive risk stratification using the validated GRACE risk model. However, ST elevation greater than 1 mm in aVR may be useful in the early identification of LM/3-vd in ACS patients with ST depression.</p>
dc.identifier.submissionpathcor_grace/55
dc.contributor.departmentCenter for Outcomes Research
dc.source.pages71-8


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