The prognostic significance of early and late right precordial lead (V4R) ST‐segment elevation in patients with acute anterior myocardial infarction

Background

The predictive significance of ST‐segment elevation (STE) in lead V₄R in patients with anterior ST‐segment elevation myocardial infarction (STEMI) has not been well‐understood. In this study, we evaluated the prognostic value of early and late STE in lead V₄R in patients with anterior STEMI.

Methods

A total 451 patients with anterior STEMI who treated with primary percutaneous coronary intervention (PPCI) were prospectively enrolled in this study. All patients were classified according to presence of STE (>1 mm) in lead V₄R at admission and/or 60 min after PPCI. Based on this classification, all patients were divided into three subgroups as no V₄R STE (Group 1), early but not late V₄R STE (Group 2) and late V₄R STE (Group 3).

Results

In‐hospital mortality had higher rates at group 2 and 3 and that had 2.1 and 4.1‐times higher mortality than group 1. Late V₄R STE remained as an independent risk factor for cardiogenic shock (odds ratio [OR] 2.6; 95% confidence interval [CI] 1.9–4.3; p < .001) and in‐hospital mortality (OR 2.3; 95% CI 1.8–4.1; p < .001). The 12‐month overall survival for group 1, 2, and 3 were 91.1%, 82.4%, and 71.4% respectively. However, the long‐term mortality also had the higher rate at group 3; late V₄R STE did not remain as an independent risk factor for long‐term mortality (OR 1.5; 95% CI 0.8–4.1; p: .159).

Conclusion

Late V₄R STE in patients with anterior STEMI is strongly associated with poor prognosis. The record of late V₄R in patients with anterior STEMI has an important prognostic value.