The value of lead aVR to predict the culprit vessel in the acute inferior myocardial infarction

Objective To predict the infarct-related artery(IRA)in acute inferior myocardial infarc- tion(AMI)with ST-segment changes of lead aVR,through comparing the electrocardiogram to coronary angiogra- phy(CAG).Methods Sixty-five patients with inferior AMI were enrolled,of which,proximal to the right coro- nary artery occlusion was present in 26,distal to the right coronary artery in 29,and left circumflex coronary ar- tery(LCX)occlusion in 10.Analyze comparatively the changes of electrocardiogram registered in 12 hours after the acute episode.Results In the three groups,marked ST elevation in inferior leads showed no significance, with ST_(aVR)depression suggested the right coronary artery(RCA)occlusion and without ST_(aVR)depression sug- gested LCX occlusion.The proximal to the right coronary artery occlusion didn't influence ST-segment changes, and the positive predictive value(PPV)of electrocardiogram index was 96.7%.The distal to the right coronary artery occlusion contributed ST_(v_1～v_2)depression,and the PPV was 83%.The LCX occlusion also contributed ST_(v_1-v_3)depression,but didn't influenced ST_(aVR),and the PPV was 87%.Conclusion At the same time of ST elevation in inferior lead,with or without the ST_(aVR)depression is the key point to distinguish the RCA or LCX occlusion in the early inferior AMI,which takes on the important reference value to determine the reperfusion therapy and prognosis.