ST-segment depression in aVR as a predictor of culprit artery and infarct size in acute inferior wall ST-segment elevation myocardial infarction

J Electrocardiol. 2010 Mar-Apr;43(2):132-5. doi: 10.1016/j.jelectrocard.2009.09.003. Epub 2009 Oct 7.


Background: ST-segment depression in lead aVR in acute inferior wall ST-segment elevation myocardial infarction (STEMI) has recently been suggested as a predictor of left circumflex (LCx) artery involvement. The purpose of this study is to evaluate the clinical significance of aVR depression during inferior wall STEMI.

Methods: This study included 106 consecutive patients who presented with inferior wall STEMI and underwent urgent coronary angiogram. Clinical and angiographic findings were compared between patients with and without aVR depression > or = 0.1 mV.

Results: The sensitivity and specificity of aVR depression as a predictor of LCx infarction were 53% and 86%, respectively. In patients with right coronary artery infarction, aVR depression was associated with increased cardiac enzymes and the involvement of a large posterolateral branch, which may explain the larger infarction.

Conclusions: ST-segment depression in lead aVR in inferior wall STEMI predicts LCx infarction or larger RCA infarction involving a large posterolateral branch.

MeSH terms

  • Coronary Artery Disease / complications*
  • Coronary Artery Disease / diagnosis*
  • Diagnosis, Computer-Assisted / methods*
  • Electrocardiography / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / etiology*
  • Reproducibility of Results
  • Sensitivity and Specificity