ST elevation in lead aVR - a marker of critical left main coronary artery stenosis: A series of case reports and literature review.
May Thu Kyaw
✦ AI-curated · Sources linked
Case in brief
Five consecutive patients presenting with acute chest pain or cardiac arrest had ST-segment elevation of at least 1 mm in lead aVR with diffuse ST depression of at least 1 mm in six or more leads. Coronary angiography within 24 hours confirmed left main coronary artery stenosis of 70%–99% in all five. Two patients underwent coronary artery bypass grafting, two received percutaneous coronary intervention, and one was managed medically. There were no in-hospital deaths.
What made this case unusual
The ECG pattern was associated with severe left main stenosis in all five patients in this small case series, but it is not specific: the authors note it can also occur with severe anemia, shock, or aortic dissection.
Diagnostic / clinical pearl
ST elevation in aVR with widespread ST depression is a high-risk ECG pattern; in this series, it accompanied critical left main stenosis and prompted urgent angiographic evaluation.
Why it matters
The authors caution that this small retrospective series requires validation in larger prospective cohorts, so its findings should not be treated as population-level evidence.