Prognostic Value of ST-segment Deviation in Lead aVR in Electrocardiogram in Acute Myocardial Infarction

Background: Acute myocardial infarction (AMI) remains a significant cause of morbidity and mortality worldwide, necessitating effective risk stratification tools for improved management. ST-segment deviation in lead augmented vector right (aVR) has emerged as a potential prognostic marker in AMI, but its clinical relevance in the Indian context requires further investigation. Materials and Methods: We conducted a single-center prospective observational study among patients admitted with AMI to assess the prognostic value of ST-segment deviation in lead aVR. Patients were categorized based on the presence or absence of ST-segment deviation in lead aVR, and demographic, clinical, and angiographic characteristics were compared between groups. Follow-up evaluations were performed to assess left ventricular ejection fraction (LVEF) and the incidence of ventricular tachycardia (VT). Results: The study enrolled 110 patients, categorizing them by ST-segment deviation in lead aVR. Patients with ST elevation in lead aVR showed higher moderate LVEF dysfunction (31%-40%) than those with isoelectric ST segments (P = 0.0058). Conversely, patients with ST depression in lead aVR had increased preserved ejection fraction compared to those with an isoelectric ST segment (P = 0.0414). <50% ST-segment resolution postpercutaneous coronary intervention (PCI) was more common among non-ST-segment elevation myocardial infarction (NSTEMI) patients. The incidence of VT was higher in ST elevation in lead aVR (P = 0.0045). Significant differences in ST-segment resolution after PCI (P = 0.0117) between STEMI and NSTEMI patients were noted. Conclusion: ST-segment deviation in lead aVR serves as a valuable prognostic marker in AMI, correlating with adverse outcomes such as moderate LVEF dysfunction and increased risk of VT. Furthermore, its association with ST-segment resolution post-PCI highlights its role in assessing reperfusion success and guiding management strategies. These findings underscore the importance of ST-segment deviation in lead aVR for risk stratification and personalized management in AMI patients.