Determinants of ST-segment level in lead aVR in anterior wall acute myocardial infarction with ST-segment elevation

Abstract Background This study aimed to clarify the determinants of ST-segment level in lead aVR in anterior wall acute myocardial infarction (AAMI). Methods We analyzed ST-segment levels in all 12 leads on admission and emergency coronary angiographic findings in 261 patients with a first AAMI with ST-segment elevation. The length of the left anterior descending coronary artery (LAD) was classified as follows: short = not reaching the apex; medium = perfusing less than 25% of the inferior wall; long = perfusing 25% or more of the inferior wall. Results The ST-segment level in lead aVR correlated significantly with the ST-segment levels in leads I, II, III, aVF, V1 , and V3-6 , especially with those in leads II and V6 ( r = −0.63, P < .001; r = −0.61, P < .001; respectively). Patients with a proximal LAD occlusion had a greater ST-segment level in lead aVR than those with a distal LAD occlusion ( P < .001). Patients with a long LAD had a lower ST-segment level than those with a short or medium LAD ( P < .05). Conclusions The ST-segment levels, especially in leads II and V6 , the site of the LAD occlusion, and the length of the LAD affect the ST-segment level in lead aVR in ST-segment elevation AAMI.