Coronary Artery DiseasePrognostic Implications of Prominent R Wave in Electrocardiographic Leads V1 or V2 in Patients With Acute Coronary Syndrome
Section snippets
Methods
The Canadian ACS Registry I and Global Registry of Acute Coronary Events (GRACE) were prospective, multicenter, observational studies of patients admitted with ACS. The objectives and methodologies have been published previously.9, 10, 11, 12 Briefly, in the ACS I, patients ≥18 years of age with suspected acute cardiac ischemia of <24 hours of symptom onset were eligible for inclusion. In GRACE, patients had to be at least 18-year-old with a presumptive diagnosis of ACS and at least 1 of the
Results
Of the 11,895 patients in the GRACE and ACS I who had ACS and no right bundle branch block or right ventricular hypertrophy in their presenting ECG, 495 (4.2%) had PRW. Table 1 lists the baseline demographics and clinical characteristics. Figure 1 shows the location of ST-elevation on the presenting ECG.
The management and outcome during the index hospitalization and at 6 months are listed in Table 2. Figure 2 shows the angiographic findings of the 4,418 patients who underwent cardiac
Discussion
Across the broad spectrum of patients with ACS, PRW was not associated with worse outcomes. The presence of PRW was associated with lower unadjusted 6-month mortality but not in-hospital mortality. After adjusting for the established prognosticators in the GRACE risk model, PRW did not provide significant incremental prognostic value and did not improve the risk stratification of patients with ACS.
Several studies have explored the unfavorable prognosis related to posterior myocardial infarction
Acknowledgments
We are indebted to the study investigators, coordinators, and patients who participated in the ACS I and GRACE registries and to Sue Francis, BA, for her assistance in this manuscript preparation.
References (30)
- et al.
Quantitative analysis of the admission electrocardiogram identifies patients with unstable coronary artery disease who benefit the most from early invasive treatment
J Am Coll Cardiol
(2003) - et al.
Prominent R wave and shallow S wave in Lead V1 as a result of lateral myocardial infarction
Am Heart J
(1950) - et al.
Baseline Q-wave surpass time from symptom onset as a prognostic marker in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention
J Am Coll Cardiol
(2009) - et al.
A comprehensive analysis of myocardial infarction due to left circumflex artery occlusion: comparison with infarction due to right coronary artery and left anterior descending artery occlusion
J Am Coll Cardiol
(1988) - et al.
Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE)
Am J Cardiol
(2002) - et al.
One-year outcome of patients after acute coronary syndromes (from the Canadian acute coronary syndromes registry)
Am J Cardiol
(2004) - et al.
Development and prognosis of non-Q-wave myocardial infarction in the thrombolytic era
Am Heart J
(2002) - et al.
Clinical trial–derived risk model may not generalize to real-world patients with acute coronary syndrome
Am Heart J
(2004) - et al.
Prevalence and outcome of ST-segment elevation in posterior electrocardiographic leads during acute myocardial infarction case report and review of electrocardiographic diagnosis
J Electrocardiol
(1999) - et al.
Acute myocardial infarction with isolated ST-segment elevation in posterior chest leads V7-9 “hidden” ST-segment elevations revealing acute posterior infarction
J Am Coll Cardiol
(1999)
Significance of ST segment elevations in posterior chest leads (V7 to V9) in patients with acute inferior myocardial infarction: application for thrombolytic therapy
J Am Coll Cardiol
Value of leads V7-V9 in diagnosing posterior Wall acute myocardial infarction and other causes of tall R waves in V1-V2
Am J Cardiol
Initial Q waves accompanying ST-segment elevation at presentation of acute myocardial infarction and 30-day mortality in patients given streptokinase therapy: an analysis from HERO-2
Lancet
Clinical implications of a next-day follow-up electrocardiogram in patients with non-ST elevation acute coronary syndromes
Am Heart J
Concordance of electrocardiographic patterns and healed myocardial infarction location detected by cardiovascular magnetic resonance
Am J Cardiol
Cited by (0)
Dr. Andrew Yan is supported by a New Investigator Award from the Heart and Stroke Foundation, Ottawa, Ontario, Canada. GRACE was sponsored by an unrestricted grant from Sanofi-Aventis and Bristol-Myers Squibb. The Canadian ACS Registries were sponsored by the Canadian Heart Research Center, Key Pharmaceuticals, Pfizer Canada Inc., Sanofi-Aventis Canada, and Bristol Myers Squibb Canada. The industrial sponsors had no involvement in the study conception or design; collection, analysis, and interpretation of data; in the writing, review, or approval of the manuscript; and in the decision to submit the manuscript for publication.
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