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Background: Acute coronary syndrome (ACS) encompasses a collection of three acute processes related to myocardial ischemia. These include: unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI). The 12-lead electrocardiogram (ECG) is a crucial tool in the diagnosis and risk stratification of ACS. Unlike the other 11 leads, lead augmented Vector Right (aVR) has been long neglected until recent years. Recent investigations have shown that an analysis of ST-segment shift in lead aVR provides useful information on the coronary angiographic anatomy and risk stratification in ACS. This implies that the use of lead aVR can be effective in the early detection and extent of tissue ischemia, increasing the chances of acute myocardial infarction (AMI) survival. Objective: The purpose of this review is to determine whether the use of lead aVR can be used as a STEMI equivalent compared to the standard STEMI criteria as defined by the American Heart Association to predict proximal left anterior descending (LAD) or left main coronary artery (LMCA) occlusion in order to decrease door to balloon time and overall mortality. Methods: A PubMed search was conducted using the following search terms and filters: aVR, STEMI, and myocardial infarction articles in the last 10 years, English language, randomized control trials, meta-analysis reviews. Articles were excluded if not specific to lead aVR, emphasis on treatment rather than diagnosis, no full text of the article was available, and low participant numbers. Conclusion: While the use of lead aVR in insolation as a STEMI equivalent remains unclear, there is evidence supporting that ST elevation in lead aVR is associated with higher mortality in the presence of a recognized STEMI. It is also suggested that ST elevation (STE) in lead aVR may involve the LAD or all three main coronary arteries (triple vessel disease). This is promising in early recognition of tissue ischemia and can be used as a potential marker of disease severity.
Keywords: Left Anterior Descending Coronary Artery (LAD); Left Main Coronary Artery (LMCA); Left Bundle Branch Block (LBBB); Right Bundle Branch Block (RBBB); Percutaneous Coronary Intervention (PCI); Coronary artery disease (CAD); ST segment elevation myocardial infarction (STEMI); Non-ST segment elevation myocardial infarction (NSTEMI), ST segment elevation (STE).
Hayes KA, Vu, PM. Diagnostic Effectiveness of Lead aVR as a STEMI Equivalent. JMU Scholarly Commons Physician Assistant Capstones. https://commons.lib.jmu.edu/pacapstones/36/. Published December 12, 2018.