Relationship between ST-Segment Shifts in Lead aVR and Coronary Complexity in Patients with Acute Coronary Syndrome.

Background: ST-segment shifts in lead aVR are associated with increased coronary atherosclerosis. However, there is insufficient data about the relationship between ST-segment shifts in lead aVR and coronary complexity. The aim of this study was to investigate this relationship. Methods: This prospective, observational study included 236 patients with acute coronary syndrome who underwent coronary angiography. Electrocardiograms on presentation were reviewed in terms of ST-segment shifts in lead aVR. Inter-observer agreement was analyzed using kappa statistics for the presence of aVR lead ST segment shifts. The patients were divided into two groups according to their Sx scores (≤ 22 and > 22). Results: The mean age of the study population was 62.19 ± 12 years. Eighty-seven patients (37%) had complex coronary artery disease as defined by intermediate-high Sx scores, and 130 patients (55%) had ST-segment shifts in lead aVR. In multivariate logistic regression analysis, ST-segment elevation or depression ≥ 1 mm were independently associated with intermediate-high Sx scores. Conclusions: In patients with acute coronary syndrome, the presence of ST-segment elevation or depression ≥ 1 mm in lead aVR may indicate coronary complexity.