Abstract 11275: ST-Segment Elevation in Lead aVR Strongly Predicts In-hospital Mortality in Patients With Type A Acute Aortic Dissection

Introduction: Early identification of high-risk patients is crucial for appropriate management in type A acute aortic dissection (AAD). ECG is useful for this purpose because it is readily available and rapidly interpretable at presentation. Hypothesis: In type A AAD, ischemic ST-T change at presentation is associated with poor outcomes. ST-segment elevation in lead aVR (ST↑aVR) is an ECG marker of severe acute myocardial ischemia, and therefore, may provide important prognostic information. Methods: We studied the relation of ECG findings to clinical features on admission and in-hospital death in 294 patients who were admitted within 12 h from symptom onset and underwent urgent surgery for type A AAD. Patients with bundle branch block or left ventricular hypertrophy were excluded. Patients were divided into the 3 groups according to admission ECG findings: no significant ST-T changes (n=99, G-A); the absence (n=151, G-B) or the presence (n=44, G-C) of ST↑aVR ≥0.5 mm with ST-T changes in other leads. Hemoglobin (Hb), creatinine (Cr), D-dimer, and cardiac-specific troponin were measured on admission. Results: There were no differences in age, sex, time to admission or Hb level in the 3 groups. In G-A, G-B, and G-C, systolic blood pressure was 130±23, 131±33, and 88±27 mmHg (p Conclusions: In patients with type A AAD, ST↑aVR on admission ECG strongly predicts in-hospital death. Our findings suggest that ST↑aVR is a simple but reliable tool for an early identification of high-risk patients.