The Added Value of ST-Elevation in Lead aVR to Clinical TIMI Score in Predicting the Angiographic Severity of Coronary Artery Disease in Patients with Non ST-Elevation Myocardial Infarction

Abstract

lectrocardiography is an appropriate bedside tool used in the Emergency Department to make a rapid diagnosis of ACS, allowing physicians to select appropriate therapy and to predict potential cardiovascular complications. The ability to discriminate among the various coronary artery obstruction patterns may influence early management decisions. In patients with non-ST-segment elevation myocardial infarction (NSTE-MI), identification of left main and/or 3-vessel disease (LM/3VD) is crucial for prediction of the angiographic severity and the possibility of surgical intervention in such condition. The clinical TIMI risk score, a simple 7-points tool was developed to stratify NST-EACS patients into low, intermediate & high risk groups. Although it correlated well with the severity of CAD with each increase in the score, it was found to be less sensitive in low & intermediate risk populations. Thus TIMI score needs more additive tools to stratify patients for the proper treatment strategy. The aim of this study was to investigate the added value of the presence of ST-segment elevation in lead aVR of the 12 lead admission electrocardiogram to the TIMI clinical scoring system in predicting the severity of coronary artery disease by doing coronary angiography for 150 patients presenting to ED with NSTEMI.