Recording lead V(4)R is associated to enhanced use of fibrinolytic therapy in acute myocardial infarction |
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Authors: | Harju Jarkko A Eskola Markku J Huhtala Heini Niemelä Kari O Karhunen Pekka J Nikus Kjell C |
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Affiliation: | aSchool of Medicine, University of Tampere, 33520 Tampere, Finland;bHeart Center, Tampere University Hospital, 33520 Tampere, Finland;cSchool of Public Health, University of Tampere, 33520 Tampere, Finland;dResearch Unit of the Laboratory Centre, Tampere University Hospital, 33520 Tampere, Finland |
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Abstract: | BackgroundST-segment elevation in the right-sided chest lead V4R in inferior wall myocardial infarction is recognized as a sign of proximal occlusion of the right coronary artery with evolving right ventricular myocardial infarction. Our objective is to study how often lead V4R is recorded in clinical practice and how this might be associated with use of reperfusion therapy and outcome of patients.MethodsRecording of lead V4R in 814 consecutive patients with acute myocardial infarction, administration of therapy, and outcome of the patients during a median follow-up of 285 days (174-313 days) were studied.ResultsV4R was recorded in 52% of patients with inferior ST-elevation myocardial infarction. Patients with V4R recorded were more likely to receive fibrinolytic therapy compared with patients without recording (65% vs 51%; P = .035). In multivariate analysis, recording of lead V4R (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.1-2.2; P = .006), along with age (P < .001), previous myocardial infarction (OR 2.2, 95% CI 1.3-3.5; P = .002), and diabetes (OR 3.9, 95% CI 1.1-2.4; P = .03) correlated to the use of reperfusion therapy. Patients with lead V4R recorded had less (P = .055) reinfarction, unstable angina, stroke, and/or death during follow-up.ConclusionsLead V4R was recorded in only half of patients with inferior ST-elevation myocardial infarction. Patients with V4R recorded were more likely to receive thrombolytic therapy than those without recording of the additional chest lead. |
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Keywords: | Lead V4R Fibrinolytic therapy Acute myocardial infarction Right ventricular infarction |
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