Journal of electrocardiology · 2026
The value of ST-segment deviation in lead aVR for predicting the infarct-related artery in acute inferior STEMI: A systematic review and meta-analysis.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод пока не подготовлен
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Li Yang-Yu, Zeng Fang, Deng Ju, Huang Bin, Yan Guang-Dong, Chen Xi-Wei, Li Biao, Chen Yao-Gui, Yang Hui, Zhao Qiang, Li Li
Аннотация
BACKGROUND: The infarct-related artery (IRA) in acute inferior wall ST-segment elevation myocardial infarction (inferior STEMI) is predominantly the left circumflex artery (LCX) or the right coronary artery (RCA). Electrocardiographic ST-segment deviation in lead aVR has shown potential value in predicting the IRA, but systematic evidence is lacking.
METHODS: A comprehensive literature search was undertaken across Web of Science, PubMed, and Scopus to identify relevant studies published until March 2025. Pooled sensitivity and specificity were calculated using a bivariate effects model. Overall accuracy was quantified by the diagnostic odds ratio (DOR) and area under the curve (AUC).
RESULTS: Twenty-four studies (6416 participants) were included. For LCX prediction, aVR ST-segment depression (aVR-STD) demonstrated pooled sensitivity of 0.62 (95% CI: 0.51-0.72), specificity of 0.81 (95% CI: 0.75-0.86), and good overall accuracy [DOR = 7.01 (95% CI: 3.72-13.22), AUC = 0.80 (95% CI: 0.76-0.83)]. Conversely, aVR ST-segment elevation (aVR-STE) was a poor predictor for LCX [sensitivity = 0.02 (95% CI: 0.01-0.08), AUC = 0.55 (95% CI: 0.51-0.59)]. For RCA prediction, aVR-STE demonstrated pooled sensitivity of 0.06 (95% CI: 0.03-0.13), specificity of 0.97 (95% CI: 0.93-0.98), and moderate overall accuracy [DOR = 1.99 (95% CI: 1.15-3.43), AUC = 0.75 (95% CI: 0.71-0.79)]. aVR-STD was a poor predictor for RCA [sensitivity = 0.19 (95% CI: 0.13-0.27), AUC = 0.23 (95% CI: 0.19-0.27)]. Heterogeneity analysis identified the ST-segment reference point and smoking history as potential contributors.
CONCLUSION: In inferior STEMI, aVR-STD demonstrates significant value in predicting LCX as the IRA, while its accuracy appears moderated by the ST-segment measurement reference point and smoking history. Conversely, aVR-STE shows limited predictive value for RCA.
METHODS: A comprehensive literature search was undertaken across Web of Science, PubMed, and Scopus to identify relevant studies published until March 2025. Pooled sensitivity and specificity were calculated using a bivariate effects model. Overall accuracy was quantified by the diagnostic odds ratio (DOR) and area under the curve (AUC).
RESULTS: Twenty-four studies (6416 participants) were included. For LCX prediction, aVR ST-segment depression (aVR-STD) demonstrated pooled sensitivity of 0.62 (95% CI: 0.51-0.72), specificity of 0.81 (95% CI: 0.75-0.86), and good overall accuracy [DOR = 7.01 (95% CI: 3.72-13.22), AUC = 0.80 (95% CI: 0.76-0.83)]. Conversely, aVR ST-segment elevation (aVR-STE) was a poor predictor for LCX [sensitivity = 0.02 (95% CI: 0.01-0.08), AUC = 0.55 (95% CI: 0.51-0.59)]. For RCA prediction, aVR-STE demonstrated pooled sensitivity of 0.06 (95% CI: 0.03-0.13), specificity of 0.97 (95% CI: 0.93-0.98), and moderate overall accuracy [DOR = 1.99 (95% CI: 1.15-3.43), AUC = 0.75 (95% CI: 0.71-0.79)]. aVR-STD was a poor predictor for RCA [sensitivity = 0.19 (95% CI: 0.13-0.27), AUC = 0.23 (95% CI: 0.19-0.27)]. Heterogeneity analysis identified the ST-segment reference point and smoking history as potential contributors.
CONCLUSION: In inferior STEMI, aVR-STD demonstrates significant value in predicting LCX as the IRA, while its accuracy appears moderated by the ST-segment measurement reference point and smoking history. Conversely, aVR-STE shows limited predictive value for RCA.