PMID- 30639554
OWN - NLM
STAT- MEDLINE
DCOM- 20200107
LR  - 20200107
IS  - 1555-7162 (Electronic)
IS  - 0002-9343 (Linking)
VI  - 132
IP  - 5
DP  - 2019 May
TI  - aVR ST Segment Elevation: Acute STEMI or Not? Incidence of an Acute Coronary 
      Occlusion.
PG  - 622-630
LID - S0002-9343(19)30049-X [pii]
LID - 10.1016/j.amjmed.2018.12.021 [doi]
AB  - BACKGROUND: Identification of ST elevation myocardial infarction (STEMI) is 
      critical because early reperfusion can save myocardium and increase survival. ST 
      elevation (STE) in lead augmented vector right (aVR), coexistent with multilead 
      ST depression, was endorsed as a sign of acute occlusion of the left main or 
      proximal left anterior descending coronary artery in the 2013 STEMI guidelines. 
      We investigated the incidence of an acutely occluded coronary in patients 
      presenting with STE-aVR with multilead ST depression. METHODS: STEMI activations 
      between January 2014 and April 2018 at the University of Arizona Medical Center 
      were identified. All electrocardiograms (ECGs) and coronary angiograms were 
      blindly analyzed by experienced cardiologists. Among 847 STEMI activations, 99 
      patients (12%) were identified with STE-aVR with multilead ST depression. 
      RESULTS: Emergent angiography was performed in 80% (79/99) of patients. 
      Thirty-six patients (36%) presented with cardiac arrest, and 78% (28/36) 
      underwent emergent angiography. Coronary occlusion, thought to be culprit, was 
      identified in only 8 patients (10%), and none of those lesions were left main or 
      left anterior descending occlusions. A total of 47 patients (59%) were found to 
      have severe coronary disease, but most had intact distal flow. Thirty-two 
      patients (40%) had mild to moderate or no significant disease. However, STE-aVR 
      with multilead ST depression was associated with 31% in-hospital mortality 
      compared with only 6.2% in a subgroup of 190 patients with STEMI without STE-aVR 
      (p<0.00001). CONCLUSIONS: STE-aVR with multilead ST depression was associated 
      with acutely thrombotic coronary occlusion in only 10% of patients. Routine STEMI 
      activation in STE-aVR for emergent revascularization is not warranted, although 
      urgent, rather than emergent, catheterization appears to be important.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Harhash, Ahmed A
AU  - Harhash AA
AD  - University of Arizona Sarver Heart Center, Tucson.
FAU - Huang, Jennifer J
AU  - Huang JJ
AD  - University of Arizona Sarver Heart Center, Tucson.
FAU - Reddy, Sridhar
AU  - Reddy S
AD  - University of Arizona Sarver Heart Center, Tucson.
FAU - Natarajan, Balaji
AU  - Natarajan B
AD  - University of Arizona Sarver Heart Center, Tucson.
FAU - Balakrishnan, Mahesh
AU  - Balakrishnan M
AD  - University of Arizona Sarver Heart Center, Tucson.
FAU - Shetty, Ranjith
AU  - Shetty R
AD  - University of Arizona Sarver Heart Center, Tucson.
FAU - Hutchinson, Mathew D
AU  - Hutchinson MD
AD  - University of Arizona Sarver Heart Center, Tucson.
FAU - Kern, Karl B
AU  - Kern KB
AD  - University of Arizona Sarver Heart Center, Tucson. Electronic address: 
      kernk@email.arizona.edu.
LA  - eng
PT  - Journal Article
DEP - 20190109
PL  - United States
TA  - Am J Med
JT  - The American journal of medicine
JID - 0267200
SB  - IM
MH  - Aged
MH  - Arizona/epidemiology
MH  - *Coronary Angiography/methods/statistics & numerical data
MH  - *Coronary Disease/complications/diagnosis/epidemiology/therapy
MH  - *Coronary Occlusion/diagnosis/epidemiology/etiology/therapy
MH  - Coronary Vessels/diagnostic imaging
MH  - *Electrocardiography/methods/statistics & numerical data
MH  - Emergency Medical Services/methods/statistics & numerical data
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - *Myocardial Revascularization/methods/statistics & numerical data
MH  - Outcome and Process Assessment, Health Care
MH  - Patient Selection
MH  - Retrospective Studies
MH  - *ST Elevation Myocardial Infarction/diagnosis/epidemiology/etiology/therapy
MH  - Severity of Illness Index
OTO - NOTNLM
OT  - Augmented vector right (aVR)
OT  - Coronary angiography
OT  - Electrocardiogram (ECG) criteria
OT  - ST elevation myocardial infarction (STEMI)
EDAT- 2019/01/15 06:00
MHDA- 2020/01/08 06:00
CRDT- 2019/01/15 06:00
PHST- 2018/11/28 00:00 [received]
PHST- 2018/12/13 00:00 [revised]
PHST- 2018/12/13 00:00 [accepted]
PHST- 2019/01/15 06:00 [pubmed]
PHST- 2020/01/08 06:00 [medline]
PHST- 2019/01/15 06:00 [entrez]
AID - S0002-9343(19)30049-X [pii]
AID - 10.1016/j.amjmed.2018.12.021 [doi]
PST - ppublish
SO  - Am J Med. 2019 May;132(5):622-630. doi: 10.1016/j.amjmed.2018.12.021. Epub 2019 
      Jan 9.